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General NPI Number Information
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NPI Number | 1831556737
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Entity Type | Organization
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Legal Business Name | CLINICA BUENA VIDA LLC
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 19703 CREEK BEND TRL
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City | HOUSTON
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State | TX
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Zip | 77084-4380
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Country | US
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Telephone | 281-704-9046
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Fax |
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Provider Business Mailing Address
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Address Line | 19703 CREEK BEND TRL
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City | HOUSTON
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State | TX
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Zip | 77084-4380
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Country | US
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Telephone | 281-704-9046
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | YUNIOR JIMENEZ-PEREZ
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Credential |
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Telephone | 281-704-9046
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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 |
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License Number State | TX
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