Provider Demographics
NPI:1023503323
Name:HOUSTON CLINICA FAMILIA 2 LLC
Entity type:Organization
Organization Name:HOUSTON CLINICA FAMILIA 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:YAIMARA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PANTOJA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:713-695-7600
Mailing Address - Street 1:232 E CROSSTIMBERS ST STE E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-4499
Mailing Address - Country:US
Mailing Address - Phone:713-695-7600
Mailing Address - Fax:713-695-7602
Practice Address - Street 1:232 E CROSSTIMBERS ST STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-4499
Practice Address - Country:US
Practice Address - Phone:713-695-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX875276164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
875276OtherTEXAS BOARD OF NURSE PRACTITIONER