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General NPI Number Information
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NPI Number | 1225332661
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Entity Type | Organization
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Legal Business Name | YOUR FIRST CLASS MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 13415 WOODFOREST BLVD
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City | HOUSTON
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State | TX
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Zip | 77015-2922
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Country | US
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Telephone | 713-453-9400
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Fax | 210-541-8841
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Provider Business Mailing Address
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Address Line | 13415 WOODFOREST BLVD
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City | HOUSTON
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State | TX
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Zip | 77015-2922
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Country | US
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Telephone | 713-453-9400
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Fax | 210-541-8841
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSA A FUENTES
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Credential | M.D.
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Telephone | 713-453-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | K1817
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License Number State | TX
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