MEDICARE: MRS. RHEA GIANNA CHARLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker	F007790	TX

General Provider Information

NPI Number	:	1134311590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHEA GIANNA CHARLES

Provider Business Mailing Address
First Line	:	2626 S LOOP W
Second Line	:	SUITE 320
City	:	HOUSTON
State	:	TX
Zip	:	77054-2649
Country	:	US
Telephone Number	:	713-665-8474
Fax Number	:	713-665-8919

Provider Business Practice Location Address
First Line	:	2626 S LOOP W
Second Line	:	SUITE 320
City	:	HOUSTON
State	:	TX
Zip	:	77054-2653
Country	:	US
Telephone Number	:	713-665-8474
Fax Number	:	713-665-8919

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2007
Last Update Date	:	04/23/2009

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