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General NPI Number Information
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NPI Number | 1922353747
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Entity Type | Organization
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Legal Business Name | PERSONALIZED WELLNESS MANAGEMENT OF HOUSTON PA
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 1415 S VOSS RD SUITE 200
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City | HOUSTON
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State | TX
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Zip | 77057-1052
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Country | US
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Telephone | 713-781-7332
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Fax |
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Provider Business Mailing Address
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Address Line | 710 N POST OAK RD SUITE 204
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City | HOUSTON
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State | TX
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Zip | 77024-3846
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Country | US
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Telephone | 713-772-7867
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Fax | 832-201-9192
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Authorized Official
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Title or Position | VP OF CLINICAL AFFAIRS
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Name | ALBERT A YEN
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Credential | M.D.
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Telephone | 713-772-7867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | D2109
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License Number State | TX
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