Healthcare Provider Details

I. General information

NPI: 1306201322
Provider Name (Legal Business Name): BAYLOR COLLEGE OF MEDICINE TEJANO CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 BROADWAY ST
HOUSTON TX
77017-1706
US

IV. Provider business mailing address

1504 TAUB LOOP # 1A29
HOUSTON TX
77030-1608
US

V. Phone/Fax

Practice location:
  • Phone: 713-640-3730
  • Fax: 713-440-9238
Mailing address:
  • Phone: 713-440-7313
  • Fax: 713-440-9238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28727
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CAROLINA SALAZAR
Title or Position: R.N.
Credential:
Phone: 713-440-7313