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NPI Code Detail

MEDICARE: MINERVA LUIS LLC

MEDICARE: MINERVA LUIS 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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1538825187
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINERVA LUIS LLC
Provider Business Mailing Address
First Line : 6400 WESTPARK DR STE 430
Second Line :
City : HOUSTON
State : TX
Zip : 77057-7276
Country : US
Telephone Number : 713-977-6917
Fax Number :
Provider Business Practice Location Address
First Line : 6400 WESTPARK DR STE 430
Second Line :
City : HOUSTON
State : TX
Zip : 77057-7276
Country : US
Telephone Number : 713-977-6917
Fax Number :
Authorized Official
Title or Position : ADMIN
Name : DAVID ORELLANA
Credential :
Telephone Number : 713-977-6917
Provider Enumeration Date : 11/09/2021
Last Update Date : 11/09/2021

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Directions to “MINERVA LUIS LLC ” Practice Location

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