Provider Demographics
NPI:1396825659
Name:HANSON, IMELDA CELINE (MD)
Entity Type:Individual
Prefix:
First Name:IMELDA
Middle Name:CELINE
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2316
Mailing Address - Country:US
Mailing Address - Phone:832-822-3555
Mailing Address - Fax:832-825-3308
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2316
Practice Address - Country:US
Practice Address - Phone:832-822-3555
Practice Address - Fax:832-825-3308
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF16102080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP080029G8Medicaid
TXP080029G8Medicaid
E75669Medicare UPIN