MEDICARE: HAVANA MEDICAL GROUP CORP

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	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1861628505	OTHER	TX	MOLINA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1861628505	OTHER		AETNA
4	1861628505	OTHER	TX	COMMUNITY HEALTH CHOICE
5	1861628505	OTHER	TX	BLUE CROSS BLUE SHIELD
6	1861628505	OTHER	TX	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1679270623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVANA MEDICAL GROUP CORP

Provider Business Mailing Address
First Line	:	715 TELEPHONE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3117
Country	:	US
Telephone Number	:	832-871-4777
Fax Number	:	832-871-4776

Provider Business Practice Location Address
First Line	:	715 TELEPHONE RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023-3117
Country	:	US
Telephone Number	:	832-871-4777
Fax Number	:	832-871-4776

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. NORBE LUIS BASULTO BARCELAY
Credential	:	NP
Telephone Number	:	786-556-8819

Provider Enumeration Date	:	02/09/2023
Last Update Date	:	03/31/2023

Similar Medicare Providers

1568169936 — HAVANA MEDICAL GROUP CORP
Practice Location Address:

715 TELEPHONE RD.
HOUSTON, TX
77023-3117

Practice Phone: 832-871-4777
Practice Fax: 832-871-4776

1982405429 — MARA FAMILY CLINIC LLC
Practice Location Address:

715 TELEPHONE RD
HOUSTON, TX
77023-3117

Practice Phone: 832-871-4777
Practice Fax:

1811989502 — HEALTHCARE EMS
Practice Location Address:

7707 HOLLOW GLEN LN
HOUSTON, TX
77072-3117

Practice Phone: 832-755-5533
Practice Fax: 281-776-0771

1043782600 — IBRAHIN RODRIGUEZ MATOS RN
Practice Location Address:

5825 GULFTON ST APT 3117
HOUSTON, TX
77081-2519

Practice Phone: 832-342-4575
Practice Fax:

1053949990 — LIANED PEREZ MERCADO MD
Practice Location Address:

9710 HARROWGATE DR
HOUSTON, TX
77031-3117

Practice Phone: 787-628-5576
Practice Fax:

1386268076 — LAILA TUBAILA FACPM/ CHES-MPH
Practice Location Address:

7703 HOLLOW GLEN LN
HOUSTON, TX
77072-3117

Practice Phone: 832-800-1309
Practice Fax:

Directions to “HAVANA MEDICAL GROUP CORP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.