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General NPI Number Information
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NPI Number | 1326257775
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Entity Type | Organization
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Legal Business Name | WESTBURY MEDICAL CLINIC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 3400 BISSONNET ST STE 165
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City | HOUSTON
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State | TX
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Zip | 77005-2157
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Country | US
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Telephone | 713-662-3199
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Fax | 713-667-1347
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Provider Business Mailing Address
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Address Line | 3400 BISSONNET ST STE 165
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City | HOUSTON
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State | TX
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Zip | 77005-2157
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Country | US
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Telephone | 713-662-3199
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Fax | 713-667-1347
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MR. ALAN E NOLASCO
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Credential | MD
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Telephone | 713-662-3199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L1955
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License Number State | TX
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