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General NPI Number Information
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NPI Number | 1902158744
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Entity Type | Organization
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Legal Business Name | CE KING MEDICAL CLINIC
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 8514 C E KING PKWY STE M
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City | HOUSTON
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State | TX
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Zip | 77044-2350
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Country | US
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Telephone | 281-459-9947
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Fax |
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Provider Business Mailing Address
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Address Line | 8514 C E KING PKWY STE M
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City | HOUSTON
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State | TX
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Zip | 77044-2350
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Country | US
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Telephone | 281-459-9947
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. VIRGILIO CABIOC GERNALE SR.
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Credential | MD
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Telephone | 281-459-9947
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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 | J9049
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License Number State | TX
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