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General NPI Number Information
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NPI Number | 1538334461
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Entity Type | Organization
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Legal Business Name | SOUTHEAST TEXAS FAMILY HEALTH & WELLNESS CENTER
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 03/25/2013
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Provider Practice Location Address
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Address Line | 220 STRICKLAND DR
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City | ORANGE
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State | TX
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Zip | 77630-4750
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Country | US
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Telephone | 409-883-4900
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Fax | 409-883-4913
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Provider Business Mailing Address
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Address Line | PO BOX 2859
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City | ORANGE
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State | TX
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Zip | 77631-0000
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Country | US
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Telephone | 409-883-4900
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Fax | 409-883-4913
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. PHILIP MARTINEZ CANTU
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Credential | M.D.
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Telephone | 409-883-4900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | K2865
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | K2865
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K2865
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License Number State | TX
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