Healthcare Provider Details

I. General information

NPI: 1104230895
Provider Name (Legal Business Name): HOUSTON INTENSIVE CARE MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11920 ASTORIA BLVD STE 320
HOUSTON TX
77089-6097
US

IV. Provider business mailing address

11920 ASTORIA BLVD STE 320
HOUSTON TX
77089-6097
US

V. Phone/Fax

Practice location:
  • Phone: 281-484-9369
  • Fax:
Mailing address:
  • Phone: 281-484-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MIA QUINTANILLA
Title or Position: ADMINISTRATOR
Credential:
Phone: 281-484-9369