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General NPI Number Information
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NPI Number | 1891006763
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Entity Type | Individual
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Provider Name | REDIET B ARAYA PAC
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Gender | Male
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 13415 WOODFOREST BLVD
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City | HOUSTON
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State | TX
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Zip | 77015-2922
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Country | US
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Telephone | 713-453-9400
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Fax | 713-453-9402
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Provider Business Mailing Address
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Address Line | 6245 RENWICK DR APT 4202
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City | HOUSTON
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State | TX
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Zip | 77081-3803
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Country | US
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Telephone | 562-310-1270
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Fax | 713-453-9402
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA20852
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | TX
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