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General NPI Number Information
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NPI Number | 1790901387
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Entity Type | Organization
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Legal Business Name | ORTEZ MEDICAL CLINIC, P.C.
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 6925 HARRISBURG BLVD
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City | HOUSTON
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State | TX
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Zip | 77011-4627
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Country | US
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Telephone | 713-928-2283
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Fax |
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Provider Business Mailing Address
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Address Line | 6925 HARRISBURG BLVD
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City | HOUSTON
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State | TX
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Zip | 77011-4627
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Country | US
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Telephone | 713-928-2283
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GUSTAVO ADOLFO ORTEZ
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Credential | M.D.
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Telephone | 713-928-2283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | D5564
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License Number State | TX
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