MEDICARE: LONE STAR MIND & BODY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	363LF0000X	Family Nurse Practitioner
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist
3	363LA2200X	Adult Health Nurse Practitioner	TX

General Provider Information

NPI Number	:	1629592530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR MIND & BODY

Provider Business Mailing Address
First Line	:	3301 PLAINVIEW ST STE 1
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 PLAINVIEW ST STE 1
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1929
Country	:	US
Telephone Number	:	832-451-2194
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. ALFRED RAMIREZ
Credential	:	RN, NP
Telephone Number	:	832-451-2194

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	08/01/2017

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Directions to “LONE STAR MIND & BODY ” Practice Location

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