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General NPI Number Information
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NPI Number | 1487470415
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL MEDICINE & WELLNESS ASSOCIATES PLLC
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 118 ELDRIDGE RD STE A
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City | SUGAR LAND
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State | TX
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Zip | 77478-4695
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Country | US
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Telephone | 713-572-5311
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Fax | 866-591-1118
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Provider Business Mailing Address
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Address Line | 5922 SABER RIV
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City | SUGAR LAND
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State | TX
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Zip | 77479-4177
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Country | US
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Telephone | 713-572-5311
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Fax |
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Authorized Official
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Title or Position | OWNER/FAMILY NURSE PRACTITIONER
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Name | MINHAS SHAUKAT LADIWALA
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Credential | FNP
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Telephone | 713-572-5311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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