Healthcare Provider Details

I. General information

NPI: 1326531708
Provider Name (Legal Business Name): HOUSTON NEUROLOGY CLINICAL & DIAGNOSTIC CONSULTANTS COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 LA CONCHA LN STE 130
HOUSTON TX
77054-1809
US

IV. Provider business mailing address

1313 LA CONCHA LN STE 130
HOUSTON TX
77054-1809
US

V. Phone/Fax

Practice location:
  • Phone: 832-788-5492
  • Fax: 832-831-7801
Mailing address:
  • Phone: 832-788-5492
  • Fax: 832-831-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MONIKA UMMAT
Title or Position: PRACTICE MANAGER
Credential: M.D.
Phone: 832-788-5492