Provider Demographics
NPI:1811385081
Name:MARCOS HIROSHI IKEDA PA
Entity Type:Organization
Organization Name:MARCOS HIROSHI IKEDA PA
Other - Org Name:BELLISSIMA WOMENS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:HIROSHI
Authorized Official - Last Name:IKEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-692-0600
Mailing Address - Street 1:415 W LITTLE YORK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-1349
Mailing Address - Country:US
Mailing Address - Phone:713-692-0600
Mailing Address - Fax:713-699-9352
Practice Address - Street 1:415 W LITTLE YORK RD
Practice Address - Street 2:SUITE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-1349
Practice Address - Country:US
Practice Address - Phone:713-692-0600
Practice Address - Fax:713-699-9352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6375207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213947901Medicaid