Provider Demographics
NPI:1578065967
Name:ODISIO, ERIKA G L C (MD)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:G L C
Last Name:ODISIO
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 1:2139 TANGLEY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1640
Mailing Address - Country:US
Mailing Address - Phone:832-260-8630
Mailing Address - Fax:
Practice Address - Street 1:1400 PRESSLER ST # 145084
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3722
Practice Address - Country:US
Practice Address - Phone:832-260-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100555372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology