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General NPI Number Information
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NPI Number | 1205248952
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Entity Type | Organization
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Legal Business Name | COMAL MEDICAL
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 21406 PROVINCIAL BLVD
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City | KATY
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State | TX
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Zip | 77450-7587
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Country | US
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Telephone | 713-955-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 10223 BROADWAY ST SUITE P #440
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City | PEARLAND
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State | TX
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Zip | 77584-7880
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Country | US
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Telephone | 713-955-2555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICK NGUYEN
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Credential | NP-C
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Telephone | 713-955-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 777198
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License Number State | TX
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