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424b Hahlo Street Houston TX 77020 | |
| (713) 674-3326 | |
| (713) 674-5100 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 424b Hahlo Street, Houston, Texas |
| Authorized Official Name and Position | Daniel Moises Montez (CEO) |
| Authorized Official Contact | 7136743326 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
424 Hahlo St Houston TX 77020-3022 Ph: (713) 674-3326 | 424b Hahlo Street Houston TX 77020 Ph: (713) 674-3326 |
| NPI Number | 1093780280 |
|---|---|
| Provider Enumeration Date | 02/21/2006 |
| Last Update Date | 06/04/2024 |
| Medicare PECOS PAC ID | 8224940028 |
|---|---|
| Medicare Enrollment ID | O20040623000562 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093780280 | NPI | - | NPPES |
| 148477604 | Medicaid | TX |
| Provider Name | Crystal Acosta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053845859 PECOS PAC ID: 5395014955 Enrollment ID: I20210722002306 |
| Provider Name | Kaizeen Cyrus Mody |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700379013 PECOS PAC ID: 2668877838 Enrollment ID: I20241017001588 |
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