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General NPI Number Information
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NPI Number | 1588796296
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Entity Type | Organization
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Legal Business Name | N. W. HOUSTON FAMILY PRACTICE, P. A.
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 11706 FALLBROOK DR
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City | HOUSTON
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State | TX
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Zip | 77065-3510
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Country | US
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Telephone | 832-912-6282
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 692312
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City | HOUSTON
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State | TX
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Zip | 77269-2312
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Country | US
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Telephone | 832-912-6282
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Fax | 281-807-0457
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ANGELINA IBIWARI AYOOLA
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Credential | M.D.
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Telephone | 832-912-6282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K9218
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License Number State | TX
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