Provider Demographics
NPI:1790454106
Name:PETRORO, HEBER
Entity Type:Individual
Prefix:
First Name:HEBER
Middle Name:
Last Name:PETRORO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SAVOY DR STE 540
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3338
Mailing Address - Country:US
Mailing Address - Phone:713-778-1300
Mailing Address - Fax:713-778-0827
Practice Address - Street 1:6800 WEST LOOP S STE 560
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4516
Practice Address - Country:US
Practice Address - Phone:713-839-7111
Practice Address - Fax:713-778-0827
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348314363LF0000X
TX1077489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily