=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770774788
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMARY CARE CONSULTANTS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2007
-----------------------------------------------------
Last Update Date | 02/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1125 CYPRESS STATION DR STE F1
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090-3055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-957-5770
-----------------------------------------------------
Fax | 281-880-6684
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15702 AZALEA SHORES DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77070-3873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-957-5770
-----------------------------------------------------
Fax | 281-880-6684
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NAILA RAMIZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-957-5770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------