Provider Demographics
NPI:1740668797
Name:HALLEY, DEMETRIA
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:
Last Name:HALLEY
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 1:8313 SOUTHWEST FWY STE 112
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1612
Mailing Address - Country:US
Mailing Address - Phone:713-365-0101
Mailing Address - Fax:
Practice Address - Street 1:8313 SOUTHWEST FWY STE 112
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1612
Practice Address - Country:US
Practice Address - Phone:713-365-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver