Healthcare Provider Details

I. General information

NPI: 1093186728
Provider Name (Legal Business Name): SPRING BRANCH COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2015
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 JACQUELYN DR # 101
HOUSTON TX
77055-2502
US

IV. Provider business mailing address

5502 1ST ST
KATY TX
77493-2472
US

V. Phone/Fax

Practice location:
  • Phone: 713-462-6565
  • Fax: 713-732-9665
Mailing address:
  • Phone: 713-462-6565
  • Fax: 832-831-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MARLEN J TUJILLO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MBA
Phone: 713-462-6565