MEDICARE: CLINICA FAMILIAR BELLAIRE

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	261QA0005X	Ambulatory Family Planning Facility	261QA0005X	TX

General Provider Information

NPI Number	:	1851838239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA FAMILIAR BELLAIRE

Provider Business Mailing Address
First Line	:	5727 BELLAIRE BLVD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5505
Country	:	US
Telephone Number	:	936-671-9398
Fax Number	:	713-664-8300

Provider Business Practice Location Address
First Line	:	5727 BELLAIRE BLVD STE A
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5505
Country	:	US
Telephone Number	:	936-671-9398
Fax Number	:	713-664-8300

Authorized Official
Title or Position	:	CEO
Name	:	LEOPOLDO CALDERON
Credential	:
Telephone Number	:	936-671-9398

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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