MEDICARE: CLINICA HISPANA PLAZA DEL SOL LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1528492329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA HISPANA PLAZA DEL SOL LLC

Provider Business Mailing Address
First Line	:	14050 STATE HIGHWAY 249 STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-2712
Country	:	US
Telephone Number	:	281-405-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	14050 STATE HIGHWAY 249 STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77086-2712
Country	:	US
Telephone Number	:	281-405-0700
Fax Number	:	281-405-9021

Authorized Official
Title or Position	:	OWNER
Name	:	YARIEL BRIAN YENDEZ
Credential	:
Telephone Number	:	281-405-0700

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	08/28/2013

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