=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801851225
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SALVADOR RAFAEL RECIO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 12/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22710 PROFESSIONAL DR SUITE 203
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-6008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-312-8530
-----------------------------------------------------
Fax | 281-312-8532
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22698 PROFESSIONAL DR SUITE 100
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-5701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-312-8530
-----------------------------------------------------
Fax | 281-312-8532
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | J7636
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------