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General NPI Number Information
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NPI Number | 1790172187
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Entity Type | Organization
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Legal Business Name | MINT ANESTHESIA, PLLC
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 690 S LOOP 336 W SUITE 215
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City | CONROE
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State | TX
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Zip | 77304-3319
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Country | US
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Telephone | 936-228-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 690 S LOOP 336 W SUITE 215
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City | CONROE
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State | TX
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Zip | 77304-3319
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Country | US
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Telephone | 936-228-9980
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NELSON ATEMBE TAJONG
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Credential | M.D.
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Telephone | 410-530-5310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | TX
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