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General NPI Number Information
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NPI Number | 1922351865
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Entity Type | Organization
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Legal Business Name | CONRAD LO INC
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 7001 CORPORATE DR SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77036-5192
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Country | US
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Telephone | 713-777-1886
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Fax |
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Provider Business Mailing Address
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Address Line | 7001 CORPORATE DR SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77036-5192
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Country | US
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Telephone | 713-777-1886
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT SURGICAL
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Name | MR. CONRAD CALVIN LO
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Credential | PA-C
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Telephone | 713-777-1886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA04350
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License Number State | TX
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