Healthcare Provider Details

I. General information

NPI: 1073259180
Provider Name (Legal Business Name): CHRISTOPHER HLAVAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

7100 ALMEDA RD APT 1921
HOUSTON TX
77054-2135
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-1414
  • Fax:
Mailing address:
  • Phone: 850-686-6746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number988575
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: