Healthcare Provider Details

I. General information

NPI: 1346901006
Provider Name (Legal Business Name): CRISTHIAN JOSUE MELGAR ANDRADES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18951 N MEMORIAL DR
HUMBLE TX
77338-4217
US

IV. Provider business mailing address

2200 N SAM HOUSTON PKWY E APT 6222
HOUSTON TX
77032-3154
US

V. Phone/Fax

Practice location:
  • Phone: 281-540-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1004667
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: