Provider Demographics
NPI:1154653020
Name:TSAI, ILEANA Y (PAC)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:Y
Last Name:TSAI
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 272629
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77277-2629
Mailing Address - Country:US
Mailing Address - Phone:713-479-1100
Mailing Address - Fax:713-629-6032
Practice Address - Street 1:4126 SOUTHWEST FWY.
Practice Address - Street 2:STE. 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027
Practice Address - Country:US
Practice Address - Phone:713-479-1100
Practice Address - Fax:713-629-6032
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01980363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical