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General NPI Number Information
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NPI Number | 1720243165
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Entity Type | Organization
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Legal Business Name | INDEPENDEN PROVIDER
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 12430 JANEY ST
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City | HOUSTON
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State | TX
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Zip | 77015-6616
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Country | US
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Telephone | 713-453-8355
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Fax |
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Provider Business Mailing Address
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Address Line | 12430 JANEY ST
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City | HOUSTON
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State | TX
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Zip | 77015-6616
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Country | US
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Telephone | 713-453-8355
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Fax |
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Authorized Official
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Title or Position | NURSING ASSISTANT
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Name | MRS. LEDYS CONCEPCION GARCIA
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Credential |
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Telephone | 713-453-8355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | NA8095978
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License Number State | TX
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