Organization
MD1961 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA PINA (OWNER)
(281) 422-9811
Entity
Organization
Contact information
Practice address
4201 GARTH RD STE 301, BAYTOWN, TX 77521-3156
(281) 422-9811
(281) 420-1262
Mailing address
4201 GARTH RD STE 301, BAYTOWN, TX 77521-3156
(281) 422-9811
(281) 420-1262
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
10/16/2018
Last updated
10/16/2018
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