Provider Demographics
NPI:1841425469
Name:DULAY, MARIO FARIN JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:FARIN
Last Name:DULAY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST STE 900
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2726
Mailing Address - Country:US
Mailing Address - Phone:713-441-3800
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN ST STE 900
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2726
Practice Address - Country:US
Practice Address - Phone:713-441-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33828103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88802AOtherBLUE CROSS BLUE SHIELD
TX1841425469OtherBLUE CROSS BLUE SHIELD
TX204512201Medicaid
TX204512203Medicaid
TX204512202Medicaid
TXP01363007OtherRR MEDICARE
TX1841425469OtherBLUE CROSS BLUE SHIELD
TX8L15582Medicare PIN