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General NPI Number Information
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NPI Number | 1720486863
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Entity Type | Individual
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Provider Name | SERVIO ANDRES WILCHES PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/05/2014
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 6812 HARRISBURG BLVD
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City | HOUSTON
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State | TX
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Zip | 77011-4626
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Country | US
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Telephone | 713-715-4460
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Fax |
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Provider Business Mailing Address
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Address Line | 122 W JOHN CARPENTER FWY STE 420
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City | IRVING
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State | TX
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Zip | 75039-2014
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Country | US
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Telephone | 516-761-0812
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 017877-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA11189
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License Number State | TX
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