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General NPI Number Information
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NPI Number | 1568829794
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Entity Type | Organization
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Legal Business Name | KATY BONE & JOINT
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 21915 SHADY HEATH LN
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City | KATY
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State | TX
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Zip | 77494-4689
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Country | US
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Telephone | 832-293-2901
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Fax |
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Provider Business Mailing Address
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Address Line | 21660 KINGSLAND BLVD
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City | KATY
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State | TX
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Zip | 77450-2511
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICOLAS MANRIQUEZ
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Credential | DPM
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Telephone | 832-293-2901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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