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General NPI Number Information
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NPI Number | 1790514032
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Entity Type | Organization
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Legal Business Name | CLINICA VIDA SANA LLC
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Dates
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Enumeration Date | 07/26/2024
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 9555 WILCREST DR STE A
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City | HOUSTON
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State | TX
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Zip | 77099-2169
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Country | US
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Telephone | 281-809-3055
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Fax | 281-809-3843
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Provider Business Mailing Address
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Address Line | 9555 WILCREST DR STE A
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City | HOUSTON
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State | TX
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Zip | 77099-2169
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Country | US
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Telephone | 281-809-3055
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOSEPH AUGUSTINE MONTES
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Credential | MD
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Telephone | 713-725-2777
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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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