Basic Information
Provider Information
NPI: 1376856450
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEMARCO VOLTZ
FirstName: ALICIA
MiddleName: ANNE
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: DEMARCO
OtherFirstName: ALICIA
OtherMiddleName: ANNE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 2 GREENWAY PLZ
Address2: SUITE 300
City: HOUSTON
State: TX
PostalCode: 770460297
CountryCode: US
TelephoneNumber: 8328283660
FaxNumber:  
Practice Location
Address1: 6701 FANNIN ST
Address2:  
City: HOUSTON
State: TX
PostalCode: 77030
CountryCode: US
TelephoneNumber: 8328283660
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/19/2010
LastUpdateDate: 08/30/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LC0200X4301096559MIN Allopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
208000000X4301096559MIN Allopathic & Osteopathic PhysiciansPediatrics 
2080P0203XA125973CAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine

No ID Information.


Home