MEDICARE: QUYNH TU VU MSPA,PA-C

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	363A00000X	Physician Assistant	PA09794	TX

General Provider Information

NPI Number	:	1326421033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUYNH TU VU MSPA,PA-C

Provider Business Mailing Address
First Line	:	6510 HILLCROFT ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4771
Country	:	US
Telephone Number	:	713-988-6677
Fax Number	:	713-988-0123

Provider Business Practice Location Address
First Line	:	6510 HILLCROFT ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4771
Country	:	US
Telephone Number	:	713-988-6677
Fax Number	:	713-988-0123

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

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	07/23/2015

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