=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629273370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLORIA B. NEMEROFF PC DBA DIAGNOSTIC SERVICES OF HOUSTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2007
-----------------------------------------------------
Last Update Date | 02/28/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5420 DASHWOOD DR SUITE 310
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77081-5357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-512-1267
-----------------------------------------------------
Fax | 713-512-1199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5420 DASHWOOD DR SUITE 310
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77081-5357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-512-1267
-----------------------------------------------------
Fax | 713-512-1199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GLORIA B NEMEROFF
-----------------------------------------------------
Credential | AUD
-----------------------------------------------------
Telephone | 713-512-1267
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | 50351
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------