Provider Demographics
NPI:1235249350
Name:MASEP INC
Entity Type:Organization
Organization Name:MASEP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GACITUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-490-1077
Mailing Address - Street 1:PO BOX 924150
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77292-4150
Mailing Address - Country:US
Mailing Address - Phone:713-490-1077
Mailing Address - Fax:713-691-2330
Practice Address - Street 1:1919 NORTH LOOP W
Practice Address - Street 2:STE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1364
Practice Address - Country:US
Practice Address - Phone:713-490-1077
Practice Address - Fax:713-691-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639250000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10014080OtherAMERIGROUP
TX159633001Medicaid
TX34JCOtherBLUE CROSS SHIELD
TX6400049OtherEVERCARE
TX34JCOtherBLUE CROSS SHIELD
TX676550Medicare ID - Type Unspecified