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General NPI Number Information
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NPI Number | 1447557780
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Entity Type | Organization
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Legal Business Name | SELAM MEDICAL CLINIC
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 03/03/2011
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Provider Practice Location Address
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Address Line | 6440 HILLCROFT ST STE 104
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City | HOUSTON
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State | TX
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Zip | 77081-3104
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Country | US
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Telephone | 562-310-1270
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Fax | 713-929-3621
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Provider Business Mailing Address
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Address Line | 6440 HILLCROFT ST STE 104
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City | HOUSTON
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State | TX
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Zip | 77081-3104
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Country | US
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Telephone | 562-310-1270
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Fax | 713-929-3621
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Authorized Official
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Title or Position | PROPRIETOR
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Name | MR. REDIET B ARAYA
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Credential | PAC
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Telephone | 562-310-1270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA06735
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License Number State | TX
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