Healthcare Provider Details

I. General information

NPI: 1346645066
Provider Name (Legal Business Name): KATY SUPPORTIVE MEDICINE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BELLA KATY DR
KATY TX
77494-6821
US

IV. Provider business mailing address

21700 BELLAIRE BLVD
RICHMOND TX
77407-3906
US

V. Phone/Fax

Practice location:
  • Phone: 281-665-4032
  • Fax: 281-665-1206
Mailing address:
  • Phone: 281-599-0300
  • Fax: 281-599-7807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberN6844
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN6844
License Number StateTX

VIII. Authorized Official

Name: SANDRA PEREZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 281-665-4032