=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386744142
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AIRLINE FAMILY PRACTICE ASSOCIATES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2006
-----------------------------------------------------
Last Update Date | 01/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11012 AIRLINE DR STE A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77037-1112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-820-8955
-----------------------------------------------------
Fax | 281-820-5541
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11012 AIRLINE DR STE A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77037-1112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-820-8955
-----------------------------------------------------
Fax | 281-820-5541
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. JOSE I GONZALEZ JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-447-1375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------