MEDICARE: BOYCEL VERDEJO

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	363A00000X	Physician Assistant	PA19434	TX

General Provider Information

NPI Number	:	1790565604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOYCEL VERDEJO

Provider Business Mailing Address
First Line	:	6431 FANNIN, JJL 270
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5656 KELLEY ST # 1EC1347
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77026-1967
Country	:	US
Telephone Number	:	832-477-7444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	12/08/2025

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Directions to “ BOYCEL VERDEJO ” Practice Location

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