Healthcare Provider Details

I. General information

NPI: 1497435390
Provider Name (Legal Business Name): CIPITIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 GROVEWAY DR
HOUSTON TX
77087-1122
US

IV. Provider business mailing address

19318 WATER BRIDGE DR
CYPRESS TX
77433-3176
US

V. Phone/Fax

Practice location:
  • Phone: 713-485-5432
  • Fax:
Mailing address:
  • Phone: 469-667-0971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. JAIME BARRACHINA
Title or Position: OWNER
Credential:
Phone: 469-667-0971