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Organization
MEDAGENE CLINIC , P.A.
Active
Organization
MEDAGENE CLINIC , P.A.
Active
Other names
MedAGene Clinic , P.A.
Organization subpart
No
Provider details
NPI number
Authorized official
GONZALO URIBEBOTERO (OWNER)
(713) 779-1633
Entity
Organization
Contact information
Practice address
5373 W ALABAMA ST, HOUSTON, TX 77056-5930
(713) 779-1633
Mailing address
9606 S RICE AVE, HOUSTON, TX 77096-4136
(713) 779-1633
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E1956
TX
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
E1956
TX
208000000X
Pediatrics Physician
E1956
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
137927302
—
TX
01
—
45D0965514
CLIA
TX
Enumeration date
06/19/2006
Last updated
04/24/2026
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