MEDICARE: DEBRA D FULL

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	3747P1801X	Personal Care Attendant	015298	TX

General Provider Information

NPI Number	:	1609331271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA D FULL

Provider Business Mailing Address
First Line	:	1120 NASA PKWY STE 405
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3366
Country	:	US
Telephone Number	:	281-333-2233
Fax Number	:	281-333-2275

Provider Business Practice Location Address
First Line	:	1120 NASA PKWY STE 405
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3366
Country	:	US
Telephone Number	:	281-333-2233
Fax Number	:	281-333-2275

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

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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Directions to “ DEBRA D FULL ” Practice Location

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