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NPI Code Detail

MEDICARE: GEMMA SICAM WALL AU.D.

MEDICARE:   GEMMA SICAM WALL  AU.D.
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
1231H00000XAudiologist51758TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18K7862OTHERTXMEDICARE PTAN

General Provider Information

NPI Number : 1538349741
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEMMA SICAM WALL AU.D.
Provider Business Mailing Address
First Line : 16103 W LITTLE YORK RD STE F
Second Line :
City : HOUSTON
State : TX
Zip : 77084-6867
Country : US
Telephone Number : 281-855-8916
Fax Number :
Provider Business Practice Location Address
First Line : 16103 W LITTLE YORK RD STE F
Second Line :
City : HOUSTON
State : TX
Zip : 77084-6867
Country : US
Telephone Number : 281-855-8916
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2007
Last Update Date : 04/20/2021

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Directions to “ GEMMA SICAM WALL AU.D.” Practice Location

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