Healthcare Provider Details

I. General information

NPI: 1982837605
Provider Name (Legal Business Name): WOODLANDS HEART AND VASCULAR INSTITUTE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MEDICAL PLAZA DR SUITE 520
SHENANDOAH TX
77380-3260
US

IV. Provider business mailing address

920 MEDICAL PLAZA DR SUITE 520
SHENANDOAH TX
77380-3260
US

V. Phone/Fax

Practice location:
  • Phone: 832-562-3974
  • Fax: 832-813-0233
Mailing address:
  • Phone: 832-562-3974
  • Fax: 832-813-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberK7017
License Number StateTX

VIII. Authorized Official

Name: DR. LAURA FERNANDES
Title or Position: PHYSICIAN
Credential: MD
Phone: 832-562-3974