Provider Demographics
NPI:1801085808
Name:ELIDIA MANAGEMENT INC.
Entity type:Organization
Organization Name:ELIDIA MANAGEMENT INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:713-922-3022
Mailing Address - Street 1:1302 WAUGH DR
Mailing Address - Street 2:PMB 443
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-3908
Mailing Address - Country:US
Mailing Address - Phone:713-922-3022
Mailing Address - Fax:
Practice Address - Street 1:2502 HULDY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-6724
Practice Address - Country:US
Practice Address - Phone:713-922-3022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00966171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty