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General NPI Number Information
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NPI Number | 1063917896
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Entity Type | Organization
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Legal Business Name | PANAMERICANA FAMILY MEDICINE CLINIC PLLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 1900 BLALOCK RD # 1900M
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City | HOUSTON
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State | TX
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Zip | 77080-5450
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Country | US
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Telephone | 713-480-9129
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Fax |
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Provider Business Mailing Address
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Address Line | 7126 RANCHERIA DR
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City | HOUSTON
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State | TX
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Zip | 77083-4330
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Country | US
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Telephone | 713-240-1221
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. CARMEN E. VEGA
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Credential | FNP-BC
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Telephone | 713-480-9129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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