Healthcare Provider Details

I. General information

NPI: 1235500166
Provider Name (Legal Business Name): VENVIDIVICI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 CULLEN PKWY STE 202
PEARLAND TX
77581-9008
US

IV. Provider business mailing address

2620 CULLEN PKWY STE 202
PEARLAND TX
77581-9008
US

V. Phone/Fax

Practice location:
  • Phone: 281-520-1495
  • Fax: 281-412-4020
Mailing address:
  • Phone: 281-520-1495
  • Fax: 281-412-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberM0081
License Number StateTX

VIII. Authorized Official

Name: JOSEPH PEREZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 281-962-4183