MEDICARE: EMANI ANGEL GASPER

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1205562451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMANI ANGEL GASPER

Provider Business Mailing Address
First Line	:	3100 CLEBURNE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 CLEBURNE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-4501
Country	:	US
Telephone Number	:	713-313-7444
Fax Number	:

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

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	07/29/2022

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Directions to “ EMANI ANGEL GASPER ” Practice Location

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