MEDICARE: HOUSTONOG 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	207V00000X	Obstetrics & Gynecology Physician	N1126	TX

General Provider Information

NPI Number	:	1245571991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTONOG PLLC.

Provider Business Mailing Address
First Line	:	1200 POST OAK BLVD APT 2803
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-3266
Country	:	US
Telephone Number	:	713-775-1017
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 NORTH LOOP W STE 224
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77018-8115
Country	:	US
Telephone Number	:	713-668-0720
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LUIS ARTURO SANDOVAL-MARTINEZ
Credential	:	MD.
Telephone Number	:	713-775-1017

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/05/2013

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