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General NPI Number Information
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NPI Number | 1144462334
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Entity Type | Organization
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Legal Business Name | BRAESWOOD VACCINE CLINIC,INC
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 11/09/2009
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Provider Practice Location Address
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Address Line | 8622 S BRAESWOOD BLVD
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City | HOUSTON
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State | TX
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Zip | 77031-1301
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Country | US
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Telephone | 832-251-0500
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Fax | 832-251-0503
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Provider Business Mailing Address
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Address Line | 1940 FOUNTAIN VIEW DR UNIT 204
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City | HOUSTON
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State | TX
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Zip | 77057-3206
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Country | US
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Telephone | 832-251-0500
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Fax | 832-251-0503
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HARMINDER S CHANA
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Credential | MD
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Telephone | 832-251-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G1258
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License Number State | TX
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