MEDICARE: FAMILY NEUROLOGY AND NEURODEVELOPMENTAL CENTER PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician

General Provider Information

NPI Number	:	1215574256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY NEUROLOGY AND NEURODEVELOPMENTAL CENTER PLLC

Provider Business Mailing Address
First Line	:	3618 EMERALD FALLS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77059-3738
Country	:	US
Telephone Number	:	281-942-8001
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 PLAINVIEW ST STE 8
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1929
Country	:	US
Telephone Number	:	281-942-8001
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISA WRIGHT
Credential	:	MD
Telephone Number	:	281-942-8001

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	05/06/2022

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