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Organization
SAN JACINTO FAMILY PRACTICE EDUCATION FOUNDATION
Active
Organization
SAN JACINTO FAMILY PRACTICE EDUCATION FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY D PENA (CREDENTIALING COORDINATOR)
(281) 420-8502
Entity
Organization
Contact information
Practice address
4301 GARTH RD, SUITE 400, BAYTOWN, TX 77521-3153
(281) 420-8400
(281) 420-8480
Mailing address
4301 GARTH RD, SUITE 400, BAYTOWN, TX 77521-3153
(281) 420-8400
(281) 420-8445
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091752801
—
TX
01
—
091752802
EPSDT
TX
Enumeration date
05/23/2006
Last updated
10/31/2011
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