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General NPI Number Information
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NPI Number | 1619275690
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Entity Type | Organization
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Legal Business Name | AMELITA LOURDES P. BASA, MD, PLLC
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 8200 WEDNESBURY LN STE 380
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City | HOUSTON
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State | TX
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Zip | 77074-2931
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Country | US
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Telephone | 713-271-2030
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Fax |
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Provider Business Mailing Address
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Address Line | 2340 SHERIDAN ST
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City | HOUSTON
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State | TX
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Zip | 77030-2018
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Country | US
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Telephone | 713-271-2030
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. AMELITA LOURDES PATRICIO BASA
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Credential | M.D.
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Telephone | 713-271-2030
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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 | K9486
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License Number State | TX
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