Healthcare Provider Details

I. General information

NPI: 1669612040
Provider Name (Legal Business Name): ANNA MARIA BUENAVENTURA AND ANAND BALASUBRAMANIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17030 NANES DR SUITE106
HOUSTON TX
77090-2503
US

IV. Provider business mailing address

17030 NANES DR
HOUSTON TX
77090-2503
US

V. Phone/Fax

Practice location:
  • Phone: 281-893-8100
  • Fax: 281-271-8457
Mailing address:
  • Phone: 281-893-8100
  • Fax: 281-271-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLA271
License Number StateCA

VIII. Authorized Official

Name: DR. ANAND BUENAVENTURA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 281-839-8100