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General NPI Number Information
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NPI Number | 1891090445
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Entity Type | Organization
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Legal Business Name | ELLA AFTER HOURS CLINIC, P.C.
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Dates
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Enumeration Date | 01/12/2011
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 2499 ELLA BLVD
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City | HOUSTON
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State | TX
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Zip | 77008-2709
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Country | US
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Telephone | 713-880-4111
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Fax | 713-880-4114
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Provider Business Mailing Address
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Address Line | 2499 ELLA BLVD
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City | HOUSTON
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State | TX
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Zip | 77008-2709
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Country | US
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Telephone | 713-880-4111
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Fax | 713-880-4114
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ADRIANA BORREGO
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Credential |
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Telephone | 713-906-4565
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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 | J5007
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License Number State | TX
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