Provider Demographics
NPI:1558711317
Name:DIMAS, EVELYN LENORA (LAT)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:LENORA
Last Name:DIMAS
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20825 SOUTHWEST FWY # 97
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6318
Mailing Address - Country:US
Mailing Address - Phone:915-241-3714
Mailing Address - Fax:
Practice Address - Street 1:7200 CAMBRIDGE ST STE 10A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4202
Practice Address - Country:US
Practice Address - Phone:713-986-6029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT 1901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist