Provider Demographics
NPI:1538218193
Name:HENAO, SERGIO (MD)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:HENAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 FROSTWOOD DR STE 135
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2401
Mailing Address - Country:US
Mailing Address - Phone:713-467-2800
Mailing Address - Fax:713-467-2892
Practice Address - Street 1:902 FROSTWOOD DR STE 135
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2401
Practice Address - Country:US
Practice Address - Phone:713-467-2800
Practice Address - Fax:713-467-2892
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE02422084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX061543OtherVALUE OPTIONS
TXP000DS26Medicaid
TXC16784Medicare UPIN
TX061543OtherVALUE OPTIONS