Healthcare Provider Details

I. General information

NPI: 1811153349
Provider Name (Legal Business Name): WELLBOUND OF HOUSTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date: 05/04/2020
Reactivation Date: 05/15/2020

III. Provider practice location address

12176 N MO PAC EXPY SUITE A
AUSTIN TX
78758-2908
US

IV. Provider business mailing address

300 SANTANA ROW STE 300
SAN JOSE CA
95128-2424
US

V. Phone/Fax

Practice location:
  • Phone: 512-833-6695
  • Fax: 512-833-6651
Mailing address:
  • Phone: 650-404-3600
  • Fax: 650-625-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARGARITA GUIZAR
Title or Position: COMPLIANCE & RISK DIRECTOR
Credential:
Phone: 650-404-3771