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General NPI Number Information
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NPI Number | 1326650128
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Entity Type | Organization
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Legal Business Name | B O G ADVANCED FAMILY MEDICAL MANAGEMENT INC
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 20127 IVORY VALLEY LN
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City | CYPRESS
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State | TX
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Zip | 77433-0030
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Country | US
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Telephone | 832-812-9598
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Fax |
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Provider Business Mailing Address
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Address Line | 20127 IVORY VALLEY LN
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City | CYPRESS
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State | TX
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Zip | 77433-0030
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Country | US
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Telephone | 832-812-9598
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARBARA YADIRA ORTIZ-GONZALEZ
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Credential | FNP
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Telephone | 832-812-9598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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