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General NPI Number Information
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NPI Number | 1932557709
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Entity Type | Organization
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Legal Business Name | DARRELL WESLEY CORNELIUS
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Dates
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Enumeration Date | 06/02/2016
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 510 BERING DR
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City | HOUSTON
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State | TX
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Zip | 77057-1457
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Country | US
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Telephone | 713-569-0245
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Fax | 405-603-2207
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Provider Business Mailing Address
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Address Line | 510 BERING DR
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City | HOUSTON
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State | TX
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Zip | 77057-1457
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Country | US
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Telephone | 713-569-0245
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Fax | 405-603-2207
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Authorized Official
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Title or Position | OWNER
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Name | DARRELL CORNELIUS
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Credential | HIS
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Telephone | 713-569-0245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number |
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License Number State |
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