Provider Demographics
NPI:1871596577
Name:STOREY, MITZI (CST)
Entity type:Individual
Prefix:
First Name:MITZI
Middle Name:
Last Name:STOREY
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BAYSHORE BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1944
Mailing Address - Country:US
Mailing Address - Phone:713-944-5550
Mailing Address - Fax:713-944-5618
Practice Address - Street 1:3333 BAYSHORE BLVD
Practice Address - Street 2:STE 200
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1944
Practice Address - Country:US
Practice Address - Phone:713-944-5550
Practice Address - Fax:713-944-5618
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93703246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX93073Medicare UPIN