Provider Demographics
NPI:1184165029
Name:IRWIN, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:IRWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1100
Mailing Address - Country:US
Mailing Address - Phone:713-855-4790
Mailing Address - Fax:
Practice Address - Street 1:3901 BELLAIRE BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1100
Practice Address - Country:US
Practice Address - Phone:713-855-4790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-11
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002907246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical