MEDICARE: CHAMPIONS POINT FAMILY CLINIC LLC

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	261QP2300X	Primary Care Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1528555307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHAMPIONS POINT FAMILY CLINIC LLC

Provider Business Mailing Address
First Line	:	5367 W RICHEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3323
Country	:	US
Telephone Number	:	281-895-3008
Fax Number	:

Provider Business Practice Location Address
First Line	:	5367 W RICHEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066
Country	:	US
Telephone Number	:	713-423-4157
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/FNP-C
Name	:	DR. RAQUEL TORRES
Credential	:	DNP, FNP-C
Telephone Number	:	281-895-3008

Provider Enumeration Date	:	04/17/2018
Last Update Date	:	07/15/2018

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