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General NPI Number Information
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NPI Number | 1225288673
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR CLINIC OF TEXAS
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 8520 KNIGHT RD
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City | HOUSTON
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State | TX
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Zip | 77054-3808
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Country | US
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Telephone | 713-790-1335
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Fax | 713-790-1044
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Provider Business Mailing Address
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Address Line | 4006 INVERNESS DR
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City | HOUSTON
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State | TX
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Zip | 77019-1006
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Country | US
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Telephone | 713-790-1335
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Fax | 713-790-1044
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Authorized Official
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Title or Position | PRESIDENT
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Name | MATTEETHRA CHANDY JACOB
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Credential | M.D.
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Telephone | 713-790-1335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | F2730
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License Number State | TX
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