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General NPI Number Information
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NPI Number | 1861786782
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Entity Type | Organization
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Legal Business Name | S.E. COMPLETE FAMILY CARE
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 1907 SOUTHMORE AVE # 5
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City | PASADENA
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State | TX
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Zip | 77502-1314
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Country | US
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Telephone | 281-501-0179
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Fax | 281-501-0183
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Provider Business Mailing Address
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Address Line | 1907 SOUTHMORE AVE # 5
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City | PASADENA
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State | TX
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Zip | 77502-1314
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Country | US
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Telephone | 281-501-0179
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Fax | 281-501-0183
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/CLINIC PHYSICIAN
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Name | DR. TRIPTESH KUMAR CHAUDHURI
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Credential | M.D.
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Telephone | 281-501-0179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | TX
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