Healthcare Provider Details

I. General information

NPI: 1356179592
Provider Name (Legal Business Name): MODYFI MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 GREENWAY PLZ STE 1100
HOUSTON TX
77046-1201
US

IV. Provider business mailing address

PO BOX 25066
HOUSTON TX
77265-5066
US

V. Phone/Fax

Practice location:
  • Phone: 409-260-7080
  • Fax:
Mailing address:
  • Phone: 409-260-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLOTTE T. ZUNIGA
Title or Position: MANAGER
Credential: MD
Phone: 409-260-7080