Healthcare Provider Details

I. General information

NPI: 1528079266
Provider Name (Legal Business Name): SWEETWATER MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16651 SOUTHWEST FWY STE 100
SUGAR LAND TX
77479-2345
US

IV. Provider business mailing address

16651 SOUTHWEST FWY STE 100
SUGAR LAND TX
77479-2345
US

V. Phone/Fax

Practice location:
  • Phone: 281-494-4900
  • Fax: 281-494-4905
Mailing address:
  • Phone: 281-494-4900
  • Fax: 281-494-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELLE MEZA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 281-494-4900