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General NPI Number Information
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NPI Number | 1275711947
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Entity Type | Organization
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Legal Business Name | MINOLAS PLACE OF TEXAS,INC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 8765 SPRING CYPRESS RD # L-179
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City | SPRING
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State | TX
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Zip | 77379-3194
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Country | US
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Telephone | 281-251-7696
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Fax |
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Provider Business Mailing Address
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Address Line | 8765 SPING CYPESS #L-179
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City | SPRING
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State | TX
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Zip | 77379
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Country | US
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Telephone | 281-251-7696
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. ROZELLA GRAY
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Credential | D.O.
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Telephone | 281-251-7696
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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 |
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License Number State | TX
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