MEDICARE: BAYLOR CULLEN TEEN HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336S0011X	Specialty Pharmacy
2	333600000X	Pharmacy	20525	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2155998	OTHER		PK

General Provider Information

NPI Number	:	1346605334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYLOR CULLEN TEEN HEALTH

Provider Business Mailing Address
First Line	:	1504 TAUB LOOP # 1A29
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1608
Country	:	US
Telephone Number	:	713-440-7313
Fax Number	:	713-440-9238

Provider Business Practice Location Address
First Line	:	5737 CULLEN BLVD # 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-1665
Country	:	US
Telephone Number	:	713-440-7313
Fax Number	:	713-440-9238

Authorized Official
Title or Position	:	R.N.
Name	:	CAROLINA SALAZAR
Credential	:
Telephone Number	:	713-440-7313

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	12/18/2015

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Directions to “BAYLOR CULLEN TEEN HEALTH ” Practice Location

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