MEDICARE: INNOVATIVE WELLNESS MEDICAL CLINIC OF TEXAS LLC

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	261Q00000X	Clinic/Center
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1841063583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE WELLNESS MEDICAL CLINIC OF TEXAS LLC

Provider Business Mailing Address
First Line	:	9344 JONES RD STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-5362
Country	:	US
Telephone Number	:	346-569-6115
Fax Number	:	832-938-5670

Provider Business Practice Location Address
First Line	:	9344 JONES RD STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77065-5362
Country	:	US
Telephone Number	:	346-569-6115
Fax Number	:	832-938-5670

Authorized Official
Title or Position	:	SITE DIRECTOR
Name	:	MARIA E HERNANDEZ
Credential	:
Telephone Number	:	346-569-6115

Provider Enumeration Date	:	11/03/2023
Last Update Date	:	06/18/2025

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