Provider Demographics
NPI:1245313154
Name:WOMENS OB/GYN CENTER PA
Entity type:Organization
Organization Name:WOMENS OB/GYN CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEYA
Authorized Official - Middle Name:JACOUB
Authorized Official - Last Name:DAFASHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-991-7603
Mailing Address - Street 1:PO BOX 890827
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-0827
Mailing Address - Country:US
Mailing Address - Phone:281-991-7603
Mailing Address - Fax:281-991-7675
Practice Address - Street 1:5119 FAIRMONT PKWY STE A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3727
Practice Address - Country:US
Practice Address - Phone:281-991-7603
Practice Address - Fax:281-991-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194529701Medicaid
TX00923WMedicare PIN