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General NPI Number Information
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NPI Number | 1336964204
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Entity Type | Organization
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Legal Business Name | TEJANO MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 5608 PINEMONT DR STE A
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City | HOUSTON
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State | TX
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Zip | 77092-2622
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Country | US
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Telephone | 832-317-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 6903 DU BOISE RD
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City | HOUSTON
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State | TX
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Zip | 77091-1607
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Country | US
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Telephone | 832-317-5351
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | FRANCISCO J AYALA
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Credential | DNP
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Telephone | 832-317-5351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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