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General NPI Number Information
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NPI Number | 1366016768
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Entity Type | Organization
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Legal Business Name | CENTERWELL SENIOR PRIMARY CARE (TX) PA
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 8708 S GESSNER RD STE K
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City | HOUSTON
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State | TX
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Zip | 77074-2916
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Country | US
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Telephone | 832-389-5272
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Fax | 877-883-3330
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Provider Business Mailing Address
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Address Line | 4700 MILLENIA BLVD STE 650
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City | ORLANDO
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State | FL
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Zip | 32839-6013
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Country | US
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Telephone | 407-447-7120
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Fax | 407-770-0661
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Authorized Official
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Title or Position | SENIOR CREDENTIALING SPROFESSIONAL
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Name | ANGIE MARTINEZ
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Credential |
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Telephone | 407-447-7120
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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 |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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