MEDICARE: VENICE CLARIN ALAGENIO PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1167005	TX

General Provider Information

NPI Number	:	1356199574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VENICE CLARIN ALAGENIO PMHNP

Provider Business Mailing Address
First Line	:	6315 GULFTON ST STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-1107
Country	:	US
Telephone Number	:	713-457-4372
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 E RENNER RD STE 120
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3581
Country	:	US
Telephone Number	:	713-457-4372
Fax Number	:	713-457-0945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	10/03/2024

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