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General NPI Number Information
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NPI Number | 1528142155
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Entity Type | Individual
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Provider Name | ANTHONY NICHOLAS RAICA MS CCCA
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/29/2012
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Provider Practice Location Address
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Address Line | 3301 W DAVIS STREET SUITE E
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City | CONROE
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State | TX
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Zip | 77304-1872
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Country | US
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Telephone | 936-788-2212
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Fax | 936-788-2231
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Provider Business Mailing Address
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Address Line | 3301 W DAVIS STREET SUITE E
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City | CONROE
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State | TX
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Zip | 77304-1872
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Country | US
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Telephone | 936-788-2212
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Fax | 936-788-2231
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 50232
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 90230
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License Number State | TX
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