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General NPI Number Information
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NPI Number | 1376138271
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Entity Type | Organization
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Legal Business Name | CLINICA GLORIA DE AMERICA
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 25188 INTERSTATE 45 N STE 1G
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City | SPRING
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State | TX
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Zip | 77386-1453
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Country | US
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Telephone | 832-299-6144
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Fax | 832-299-6155
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Provider Business Mailing Address
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Address Line | 25188 INTERSTATE 45 N STE 1G
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City | SPRING
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State | TX
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Zip | 77386-1453
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Country | US
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Telephone | 832-299-6144
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Fax | 832-299-6155
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Authorized Official
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Title or Position | MANAGER
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Name | LLENISSET ARCIA-DIAZ
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Credential |
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Telephone | 832-299-6144
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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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