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General NPI Number Information
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NPI Number | 1750370185
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Entity Type | Individual
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Provider Name | CARLOS JORGE LANDIVAR SR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7737 SOUTHWEST FWY SUITE 660
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City | HOUSTON
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State | TX
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Zip | 77074-1807
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Country | US
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Telephone | 713-778-0340
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Fax | 713-981-5226
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Provider Business Mailing Address
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Address Line | 7737 SOUTHWEST FWY SUITE 660
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City | HOUSTON
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State | TX
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Zip | 77074-1807
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | E4466
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License Number State | TX
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