Healthcare Provider Details

I. General information

NPI: 1114544640
Provider Name (Legal Business Name): ADEBO CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 RIVERSTONE BLVD STE 204
MISSOURI CITY TX
77459-5213
US

IV. Provider business mailing address

4502 RIVERSTONE BLVD STE 204
MISSOURI CITY TX
77459-5213
US

V. Phone/Fax

Practice location:
  • Phone: 832-581-7474
  • Fax: 832-384-9459
Mailing address:
  • Phone: 832-581-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SENAIT ADEBO
Title or Position: MANAGER
Credential: MD
Phone: 832-581-7474