MEDICARE: PREMIUM FAMILY PRACTICE 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1558159327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM FAMILY PRACTICE LLC

Provider Business Mailing Address
First Line	:	25201 KUYKENDAHL RD STE 300
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-3404
Country	:	US
Telephone Number	:	832-384-5550
Fax Number	:	832-384-5560

Provider Business Practice Location Address
First Line	:	25201 KUYKENDAHL RD STE 300
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-3404
Country	:	US
Telephone Number	:	713-360-9448
Fax Number	:

Authorized Official
Title or Position	:	OWNER/APRN-CNP
Name	:	DAIRON MICHELL GARCIA AGUILERA
Credential	:	APRN-CNP
Telephone Number	:	832-384-5550

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	01/15/2026

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