Provider Demographics
NPI:1992368484
Name:EL-DIQRAN, MARLYN SOLANGEL (PA-C)
Entity Type:Individual
Prefix:
First Name:MARLYN
Middle Name:SOLANGEL
Last Name:EL-DIQRAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARLYN
Other - Middle Name:SOLANGEL
Other - Last Name:DAVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2066 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2066 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-3751
Practice Address - Country:US
Practice Address - Phone:832-795-8233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant