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General NPI Number Information
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NPI Number | 1760952709
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Entity Type | Organization
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Legal Business Name | MEMORIAL MEN'S HEALTH, LP
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 01/18/2019
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Provider Practice Location Address
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Address Line | 12505 MEMORIAL DR STE 300
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City | HOUSTON
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State | TX
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Zip | 77024-6051
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Country | US
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Telephone | 713-376-9670
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Fax |
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Provider Business Mailing Address
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Address Line | 418 W 18TH ST
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City | HOUSTON
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State | TX
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Zip | 77008-3912
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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 | CMO
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Name | JEANETTE VALDIVIESO
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Credential | DO
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Telephone | 713-376-9670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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