Organization
CLINICA PROVIDENCIA,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MONICA M ALVAREZ (CREDENTIALING COORDINATOR)
(832) 649-2347
Entity
Organization
Contact information
Practice address
6829B NAVIGATION BLVD, HOUSTON, TX 77011-1452
(832) 649-2347
(832) 767-0888
Mailing address
6829B NAVIGATION BLVD, HOUSTON, TX 77011-1452
(832) 649-2347
(832) 767-0888
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G9562
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1264921
—
TX
Enumeration date
07/30/2017
Last updated
07/21/2022
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