MEDICARE: MAYLY ACANDA PA

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	PA18492	TX

General Provider Information

NPI Number	:	1669141719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYLY ACANDA PA

Provider Business Mailing Address
First Line	:	1111 NORTH LOOP W STE 900
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-4716
Country	:	US
Telephone Number	:	832-930-1202
Fax Number	:	832-304-6385

Provider Business Practice Location Address
First Line	:	1111 NORTH LOOP W STE 900
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-4716
Country	:	US
Telephone Number	:	832-930-1202
Fax Number	:	832-304-6385

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

Provider Enumeration Date	:	09/12/2021
Last Update Date	:	11/21/2024

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Directions to “ MAYLY ACANDA PA” Practice Location

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