Healthcare Provider Details

I. General information

NPI: 1225857006
Provider Name (Legal Business Name): AGEVANTX CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11003 NORTHPOINTE BLVD STE A
TOMBALL TX
77375-2384
US

IV. Provider business mailing address

11003 NORTHPOINTE BLVD STE A
TOMBALL TX
77375-2384
US

V. Phone/Fax

Practice location:
  • Phone: 281-301-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE ANDREW VALDEZ
Title or Position: OWNER
Credential: MD
Phone: 281-301-5522