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General NPI Number Information
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NPI Number | 1265720585
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Entity Type | Organization
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Legal Business Name | 59 MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 07/20/2011
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Last Update Date | 08/16/2011
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Provider Practice Location Address
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Address Line | 3500 LITTLE YORK RD
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City | HOUSTON
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State | TX
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Zip | 77093-3658
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Country | US
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Telephone | 713-691-8400
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Fax | 713-691-8402
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Provider Business Mailing Address
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Address Line | 3500 LITTLE YORK RD
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City | HOUSTON
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State | TX
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Zip | 77093-3658
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Country | US
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Telephone | 713-691-8400
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Fax | 713-691-8402
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOLORES T CASTILLO
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Credential |
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Telephone | 713-691-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | F8052
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | F8052
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | F8052
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License Number State | TX
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