Provider Demographics
NPI:1124282983
Name:CANSECO, ELVIA (MD)
Entity type:Individual
Prefix:
First Name:ELVIA
Middle Name:
Last Name:CANSECO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 NORTH LOOP W STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1354
Mailing Address - Country:US
Mailing Address - Phone:713-715-7099
Mailing Address - Fax:713-715-7063
Practice Address - Street 1:1740 W 27TH ST STE 180
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1435
Practice Address - Country:US
Practice Address - Phone:713-864-8652
Practice Address - Fax:713-864-2865
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237008207R00000X
TXP7886207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX318998YNEWMedicare PIN
TX318998YT4MMedicare PIN
TX318998YT4LMedicare PIN