MEDICARE: TEXAS VACCINE INSTITUTE CO.

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	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1740874254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS VACCINE INSTITUTE CO.

Provider Business Mailing Address
First Line	:	5210 MAYBROOK PARK LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-8084
Country	:	US
Telephone Number	:	281-844-4157
Fax Number	:

Provider Business Practice Location Address
First Line	:	21811 KATY FWY STE D102
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-1813
Country	:	US
Telephone Number	:	281-828-1893
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/MANAGER
Name	:	PABLO DE ANGULO MUNOZ
Credential	:	M.D.
Telephone Number	:	281-844-4157

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	02/24/2021

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Directions to “TEXAS VACCINE INSTITUTE CO. ” Practice Location

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