=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740384908
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLAZA OB-GYN ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 BINZ STREET SUITE 500
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-522-3333
-----------------------------------------------------
Fax | 713-522-4434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1801 BINZ STREET SUITE 500
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-522-3333
-----------------------------------------------------
Fax | 713-522-4434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | CARLY NICOLE GARCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 346-771-4826
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | E0795
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------