| Clinicaangelica | |
|
601 S Wayside Dr # B Houston TX 77011-4603 | |
| (832) 475-4430 | |
| Not Available |
| Full Name | Clinicaangelica |
|---|---|
| Speciality | Clinic/Center |
| Location | 601 S Wayside Dr # B, Houston, Texas |
| Authorized Official Name and Position | Eunice Mbesa (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 8324754430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinicaangelica 16858 Big Reed Dr Humble TX 77346-4203 Ph: () - | Clinicaangelica 601 S Wayside Dr # B Houston TX 77011-4603 Ph: (832) 475-4430 |
| NPI Number | 1265913057 |
|---|---|
| Provider Enumeration Date | 08/28/2018 |
| Last Update Date | 08/28/2018 |
| Medicare PECOS PAC ID | 5799010377 |
|---|---|
| Medicare Enrollment ID | O20190718002556 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265913057 | NPI | - | NPPES |
| 1679814115 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Eunice Mbesa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679814115 PECOS PAC ID: 0143555722 Enrollment ID: I20190718002698 |
| Provider Name | Emmah W Chombah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962954644 PECOS PAC ID: 1052646635 Enrollment ID: I20190722001117 |
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