MEDICARE: EL CENTRO DE CORAZON

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
2	172V00000X	Community Health Worker
3	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1700858446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL CENTRO DE CORAZON

Provider Business Mailing Address
First Line	:	P.O. BOX 230209
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77223
Country	:	US
Telephone Number	:	713-660-1880
Fax Number	:	713-926-9105

Provider Business Practice Location Address
First Line	:	7037 CAPITOL ST.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77011-4724
Country	:	US
Telephone Number	:	713-660-1880
Fax Number	:	713-926-9105

Authorized Official
Title or Position	:	CEO
Name	:	MS. MARCELLE ELIZABETH MIR
Credential	:	MSW
Telephone Number	:	713-660-1880

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	12/13/2024

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Directions to “EL CENTRO DE CORAZON ” Practice Location

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