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General NPI Number Information
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NPI Number | 1609002138
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Entity Type | Organization
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Legal Business Name | LEENA CHACKO M.D P.A
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 04/25/2020
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Provider Practice Location Address
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Address Line | 17320 RED OAK DR STE 260
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City | HOUSTON
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State | TX
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Zip | 77090-2643
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Country | US
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Telephone | 936-242-1728
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Fax | 936-447-9145
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Provider Business Mailing Address
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Address Line | PO BOX 131083
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City | THE WOODLANDS
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State | TX
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Zip | 77393-1083
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Country | US
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Telephone | 832-585-7967
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LEENA CHACKO
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Credential | M.D
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Telephone | 936-242-1728
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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 |
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License Number State |
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