Individual
DR. JOSE CARLOS INTERIANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1631 NORTH LOOP W, #440, HOUSTON, TX 77008-1500
(713) 861-8113
(713) 861-6010
Mailing address
1631 NORTH LOOP W, #440, HOUSTON, TX 77008-1500
(713) 861-8113
(713) 861-6010
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
H7434
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00F74B
BLUE CROSS BLUE SHIELD
TX
01
—
10014840
AMERIGROUP CHIP PROGRAM
TX
01
—
10014841
AMERIGROUP MEDICAID
TX
Enumeration date
08/26/2005
Last updated
07/09/2007
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