Provider Demographics
NPI:1952636839
Name:CHIU, CARRIE HERMOSA (MD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:HERMOSA
Last Name:CHIU
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 1:12606 W HOUSTON CENTER BLVD
Mailing Address - Street 2:200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2784
Mailing Address - Country:US
Mailing Address - Phone:281-589-9700
Mailing Address - Fax:
Practice Address - Street 1:12606 W HOUSTON CENTER BLVD
Practice Address - Street 2:200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2784
Practice Address - Country:US
Practice Address - Phone:281-589-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6222208000000X
NY250521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213638401Medicaid
TXN6222OtherTEXAS LICENSE
TX213638401Medicaid