Healthcare Provider Details

I. General information

NPI: 1104073980
Provider Name (Legal Business Name): SENTINEL NEUROLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 WELLS FARGO DR SUITE 112
HOUSTON TX
77090-4044
US

IV. Provider business mailing address

16131 N ELDRIDGE PARKWAY SUITE 200
TOMBALL TX
77377
US

V. Phone/Fax

Practice location:
  • Phone: 281-440-3500
  • Fax: 281-440-3504
Mailing address:
  • Phone: 281-440-3500
  • Fax: 281-440-3504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW CUBBAGE
Title or Position: MANAGER
Credential: MD
Phone: 281-970-5900