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Organization

VINTAGE CFM

Active
Other names
Vintage Wellness Clinic
Organization subpart
No

Provider details

NPI number
Authorized official
JOSE AREVALO APRN (NURSE PRACTITIONER/MEDICAL PROVIDER)
(918) 978-9601
Entity
Organization

Contact information

Practice address
464 PARK GROVE DR STE B, KATY, TX 77450-1571
(832) 449-8411
Mailing address
464 PARK GROVE DR STE B, KATY, TX 77450-1571
(832) 449-8411

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary

Other

Enumeration date
02/09/2022
Last updated
02/09/2022
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