Provider Demographics
NPI:1720676257
Name:CHARLES, DOROTHY MARIE (N/A)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MARIE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S LOOP W STE 698
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-5601
Mailing Address - Country:US
Mailing Address - Phone:832-687-8379
Mailing Address - Fax:
Practice Address - Street 1:2600 S LOOP W STE 698
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-5601
Practice Address - Country:US
Practice Address - Phone:832-687-8379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant