=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033805767
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MM MEDIC HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2023
-----------------------------------------------------
Last Update Date | 04/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16826 STUEBNER AIRLINE RD
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-6207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-336-6103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16826 STUEBNER AIRLINE RD
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-6207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-336-6103
-----------------------------------------------------
Fax | 346-336-6105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NP
-----------------------------------------------------
Name | MARIA MERCEDES BORJAS CASTRO
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 346-336-6103
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------