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General NPI Number Information
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NPI Number | 1629267752
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Entity Type | Organization
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Legal Business Name | CLEAR LAKE ENT, P.A
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 18100 SAINT JOHN DR SUITE 240
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City | HOUSTON
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State | TX
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Zip | 77058-3631
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Country | US
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Telephone | 281-335-7755
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Fax | 281-335-7766
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Provider Business Mailing Address
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Address Line | PO BOX 580451 LOCK BOX 157102
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City | HOUSTON
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State | TX
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Zip | 77258-0451
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Country | US
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Telephone | 281-335-7755
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Fax | 281-335-7766
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALFREDO JIMENEZ
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Credential | M.D.
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Telephone | 281-335-7755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J4653
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License Number State | TX
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