Provider Demographics
NPI:1447314745
Name:RANDAZZO, DAWN L (PA-C)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:L
Last Name:RANDAZZO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20406
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77225-0406
Mailing Address - Country:US
Mailing Address - Phone:713-661-8900
Mailing Address - Fax:713-661-5535
Practice Address - Street 1:4888 LOOP CENTRAL DR
Practice Address - Street 2:STE 540
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2227
Practice Address - Country:US
Practice Address - Phone:713-661-8900
Practice Address - Fax:713-661-5535
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D5690OtherBCBS
TX148543503Medicaid
TXP00234572Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX8D5690Medicare ID - Type Unspecified