Organization
CLINICA FAMILIAR LA LUZ LLC
Active
Other names
Clinica Familiar La Luz
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NORBE LUIS BASULTO BASULTO NP (DIRECTOR)
(713) 660-1603
Entity
Organization
Contact information
Practice address
29310 PRAIRIE ROSE CT, KATY, TX 77494-7384
(832) 937-5596
(832) 937-5596
Mailing address
29310 PRAIRIE ROSE CT, KATY, TX 77494-7384
(832) 937-5596
(832) 937-5596
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861628505
BLUE CROSS AND BLUE SHIELD
TX
05
—
1861628505
—
TX
Enumeration date
02/09/2023
Last updated
11/12/2024
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