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NPI Code Detail

MEDICARE: AVANTA HEALTH PROFESSIONALS, P A

MEDICARE: AVANTA HEALTH PROFESSIONALS, P A
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
1207R00000XInternal Medicine PhysicianK9400TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12044420454001OTHERTXTRICARE

General Provider Information

NPI Number : 1740210483
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVANTA HEALTH PROFESSIONALS, P A
Provider Business Mailing Address
First Line : 1302 N SHEPHERD DR
Second Line :
City : HOUSTON
State : TX
Zip : 77008-3752
Country : US
Telephone Number : 713-885-9899
Fax Number : 713-885-9871
Provider Business Practice Location Address
First Line : 1302 N SHEPHERD DR
Second Line :
City : HOUSTON
State : TX
Zip : 77008-3752
Country : US
Telephone Number : 713-885-9899
Fax Number : 713-885-9871
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. ANTONIO JOSE RAMOS
Credential : M.D.
Telephone Number : 713-885-9899
Provider Enumeration Date : 07/04/2006
Last Update Date : 06/30/2022

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Directions to “AVANTA HEALTH PROFESSIONALS, P A ” Practice Location

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