Healthcare Provider Details

I. General information

NPI: 1629592530
Provider Name (Legal Business Name): LONE STAR MIND & BODY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 PLAINVIEW ST STE 1
PASADENA TX
77504-1929
US

IV. Provider business mailing address

3301 PLAINVIEW ST STE 1
PASADENA TX
77504-1929
US

V. Phone/Fax

Practice location:
  • Phone: 832-451-2194
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFRED RAMIREZ
Title or Position: PARTNER
Credential: RN, NP
Phone: 832-451-2194