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Organization
HAVANA MEDICAL GROUP CORP
Active
Organization
HAVANA MEDICAL GROUP CORP
Active
Other names
Clinica Havana
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NORBE LUIS BASULTO BARCELAY NP (DIRECTOR)
(786) 556-8819
Entity
Organization
Contact information
Practice address
715 TELEPHONE RD, HOUSTON, TX 77023-3117
(832) 871-4777
(832) 871-4776
Mailing address
715 TELEPHONE RD, HOUSTON, TX 77023-3117
(832) 871-4777
(832) 871-4776
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861628505
MOLINA
TX
01
—
1861628505
AETNA
—
05
—
1861628505
—
TX
Enumeration date
02/09/2023
Last updated
03/31/2023
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