MEDICARE: PEARL HEALTHCARE, 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	363LG0600X	Gerontology Nurse Practitioner	AP118306	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992291462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	3733 WESTHEIMER RD STE 1-559
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5271
Country	:	US
Telephone Number	:	713-955-7374
Fax Number	:

Provider Business Practice Location Address
First Line	:	3733 WESTHEIMER RD STE 1-559
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-5271
Country	:	US
Telephone Number	:	713-955-7374
Fax Number	:	702-537-0985

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ALERO OBIANYOR WATERHOUSE
Credential	:	GNP-BC
Telephone Number	:	832-722-1618

Provider Enumeration Date	:	07/07/2018
Last Update Date	:	03/14/2019

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Directions to “PEARL HEALTHCARE, LLC ” Practice Location

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