MEDICARE: SANTA CLARA FAMILY CLINIC 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	208000000X	Pediatrics Physician	N6789	TX
2	207Q00000X	Family Medicine Physician	P3934	TX

General Provider Information

NPI Number	:	1255761326
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA CLARA FAMILY CLINIC PLLC

Provider Business Mailing Address
First Line	:	3420 WOODRIDGE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-3735
Country	:	US
Telephone Number	:	713-923-2273
Fax Number	:	713-923-2276

Provider Business Practice Location Address
First Line	:	3420 WOODRIDGE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-3735
Country	:	US
Telephone Number	:	713-923-2273
Fax Number	:	713-923-2276

Authorized Official
Title or Position	:	CEO
Name	:	YULIET MORA AMADOR
Credential	:	MD
Telephone Number	:	713-923-2273

Provider Enumeration Date	:	11/26/2013
Last Update Date	:	05/30/2024

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