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General NPI Number Information
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NPI Number | 1598239691
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Entity Type | Individual
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Provider Name | MARCELLUS IRVIN
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Gender | Male
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 01/12/2019
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Provider Practice Location Address
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Address Line | 1914 DEERHURST LN
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City | HOUSTON
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State | TX
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Zip | 77088-3319
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Country | US
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Telephone | 832-416-5582
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Fax |
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Provider Business Mailing Address
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Address Line | 5380 W 34TH ST # 186
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City | HOUSTON
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State | TX
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Zip | 77092-6626
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Country | US
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Telephone |
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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