Healthcare Provider Details

I. General information

NPI: 1245684596
Provider Name (Legal Business Name): PASADENA PPM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 FAIRVIEW ST.
PASADENA TX
77504-1904
US

IV. Provider business mailing address

3350 FAIRVIEW ST.
PASADENA TX
77504-1904
US

V. Phone/Fax

Practice location:
  • Phone: 713-944-9830
  • Fax: 713-944-6116
Mailing address:
  • Phone: 713-944-0189
  • Fax: 713-944-6116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICK A BOYLES
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 713-944-0189