Organization
B O G ADVANCED FAMILY MEDICAL MANAGEMENT INC
Active
Other names
B O G Advanced Family Medical
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA YADIRA ORTIZ-GONZALEZ FNP (PRESIDENT)
(832) 812-9598
Entity
Organization
Contact information
Practice address
20127 IVORY VALLEY LN, CYPRESS, TX 77433-0030
(832) 812-9598
Mailing address
20127 IVORY VALLEY LN, CYPRESS, TX 77433-0030
(832) 812-9598
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP146064
INSURANCE
TX
Enumeration date
08/21/2020
Last updated
08/21/2020
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