Healthcare Provider Details

I. General information

NPI: 1619457959
Provider Name (Legal Business Name): HIPPOCRATES DIRECT HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 14TH ST N
TEXAS CITY TX
77590-8902
US

IV. Provider business mailing address

1900 BLALOCK RD STE L
HOUSTON TX
77080-5446
US

V. Phone/Fax

Practice location:
  • Phone: 346-256-4695
  • Fax:
Mailing address:
  • Phone: 346-256-4695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS ELIZABETH HERNANDEZ
Title or Position: PRESIDENT/CEO
Credential:
Phone: 832-606-7500