Healthcare Provider Details

I. General information

NPI: 1578139978
Provider Name (Legal Business Name): HEALTH BOX PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 E. SIXTH STREET
CLAREMONT CA
91711
US

IV. Provider business mailing address

2450 HOLCOMBE BLVD STE 240
HOUSTON TX
77021-2039
US

V. Phone/Fax

Practice location:
  • Phone: 909-791-2181
  • Fax:
Mailing address:
  • Phone: 713-854-5014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: GLENN DAVIS
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 832-841-4269