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General NPI Number Information
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NPI Number | 1770112674
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Entity Type | Organization
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Legal Business Name | MENS HEALTH BELLAIRE
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Dates
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Enumeration Date | 04/03/2020
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 5103 BELLAIRE BLVD STE 240
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City | BELLAIRE
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State | TX
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Zip | 77401-4419
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Country | US
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Telephone | 832-925-7712
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Fax | 346-331-5179
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Provider Business Mailing Address
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Address Line | 5103 BELLAIRE BLVD STE 240
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City | BELLAIRE
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State | TX
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Zip | 77401-4419
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Country | US
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Telephone | 832-925-7712
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Fax | 346-331-5179
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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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