Provider Demographics
NPI:1558722850
Name:ARENA, ELSIE A
Entity Type:Individual
Prefix:
First Name:ELSIE
Middle Name:A
Last Name:ARENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 SAN PABLO DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-2120
Mailing Address - Country:US
Mailing Address - Phone:832-266-7855
Mailing Address - Fax:
Practice Address - Street 1:507 N SAM HOUSTON PKWY E # 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-4021
Practice Address - Country:US
Practice Address - Phone:832-266-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172V00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker