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General NPI Number Information
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NPI Number | 1568169936
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Entity Type | Organization
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Legal Business Name | HAVANA MEDICAL GROUP CORP
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 715 TELEPHONE RD.
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City | HOUSTON
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State | TX
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Zip | 77023-3117
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Country | US
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Telephone | 832-871-4777
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Fax | 832-871-4776
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Provider Business Mailing Address
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Address Line | 715 TELEPHONE RD.
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City | HOUSTON
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State | TX
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Zip | 77023-3117
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Country | US
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Telephone | 832-871-4777
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Fax | 832-871-4776
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Authorized Official
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Title or Position | DNP/OWNER
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Name | DR. YVDIT CONCEPCION-PEREZ
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Credential | DNP, FNP-C, APRN
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Telephone | 832-871-4777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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