Provider Demographics
NPI:1528623519
Name:HOUSTON CANCER TREATMENT & IMMUNOTHERAPY CENTER PLLC
Entity type:Organization
Organization Name:HOUSTON CANCER TREATMENT & IMMUNOTHERAPY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:DUYEN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-336-1853
Mailing Address - Street 1:2911 JOSHUA TREE LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3548
Mailing Address - Country:US
Mailing Address - Phone:832-336-1853
Mailing Address - Fax:832-663-0559
Practice Address - Street 1:1101 ALMA ST STE 106
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4559
Practice Address - Country:US
Practice Address - Phone:832-336-1853
Practice Address - Fax:832-663-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-05
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM3045OtherMEDICAL LICENSE