Healthcare Provider Details

I. General information

NPI: 1063870632
Provider Name (Legal Business Name): HOVAH HEALTHCARE P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S 8TH ST
CARRIZO SPRINGS TX
78834-3818
US

IV. Provider business mailing address

PO BOX 1597
CARRIZO SPRINGS TX
78834-7597
US

V. Phone/Fax

Practice location:
  • Phone: 830-876-9060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ2444
License Number StateTX

VIII. Authorized Official

Name: OPEYEMI FALEBITA
Title or Position: CEO
Credential: M.D
Phone: 240-247-7807