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General NPI Number Information
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NPI Number | 1760858526
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Entity Type | Organization
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Legal Business Name | GULFTON PRIMARY CARE CLINIC INC
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 2743 IMPERIA DR STE 302
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City | SUGAR LAND
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State | TX
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Zip | 77479-8988
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Country | US
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Telephone | 713-777-4040
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Fax | 713-772-9269
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Provider Business Mailing Address
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Address Line | 2473 IMPEIRA DR SUITE 302
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City | SUGAR LAND
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State | TX
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Zip | 77479
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Country | US
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Telephone | 713-777-4040
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Fax | 713-777-0404
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/CEO
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Name | DR. TASNEEM AGHA
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Credential | MD
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Telephone | 713-777-4040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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