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General NPI Number Information
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NPI Number | 1417235334
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Entity Type | Organization
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Legal Business Name | JOHN PAUL II BACK AND BONE HEALTH CENTER PLLC
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 15200 SOUTHWEST FWY STE 285
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City | SUGAR LAND
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State | TX
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Zip | 77478-3866
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Country | US
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Telephone | 832-344-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 7119 SAVANNAH GLEN LN
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City | RICHMOND
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State | TX
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Zip | 77469-7347
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Country | US
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Telephone | 832-344-7757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CESAR AUGUSTO SEVILLA
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Credential | M.D.
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Telephone | 832-344-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11494
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G2479
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License Number State | TX
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