=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497594923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLAZA MEDICA MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2024
-----------------------------------------------------
Last Update Date | 06/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 911 HARRIS AVE
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77506-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-293-8135
-----------------------------------------------------
Fax | 346-293-8136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 911 HARRIS AVE
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77506-4707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 346-293-8135
-----------------------------------------------------
Fax | 346-293-8136
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | YUNIER GONZALEZ SANCHEZ
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 832-863-0071
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------