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General NPI Number Information
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NPI Number | 1558711317
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Entity Type | Individual
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Provider Name | EVELYN LENORA DIMAS LAT
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Gender | Female
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/13/2016
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Provider Practice Location Address
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Address Line | 7200 CAMBRIDGE ST STE 10A
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City | HOUSTON
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State | TX
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Zip | 77030-4202
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Country | US
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Telephone | 713-986-6029
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Fax |
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Provider Business Mailing Address
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Address Line | 20825 SOUTHWEST FWY # 97
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City | SUGAR LAND
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State | TX
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Zip | 77479-6318
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Country | US
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Telephone | 915-241-3714
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | AT 1901
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License Number State | TX
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