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General NPI Number Information
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NPI Number | 1528039583
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Entity Type | Individual
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Provider Name | ANGELO CORBIN SR. LSA
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Gender | Male
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Dates
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Enumeration Date | 01/29/2006
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 17534 SANDY CLIFFS DR
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City | HOUSTON
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State | TX
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Zip | 77090-2064
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Country | US
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Telephone | 281-303-5870
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Fax |
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Provider Business Mailing Address
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Address Line | 17534 SANDY CLIFFS DR.
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City | HOUSTON
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State | TX
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Zip | 77090
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Country | US
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Telephone | 281-798-6695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA0110
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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