Provider Demographics
NPI:1043537012
Name:THREE ANGELS MEDICAL CLINIC INC.
Entity Type:Organization
Organization Name:THREE ANGELS MEDICAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUNTHALI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-382-3422
Mailing Address - Street 1:7111 HARWIN DR
Mailing Address - Street 2:SUITE# 277
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2129
Mailing Address - Country:US
Mailing Address - Phone:832-382-3422
Mailing Address - Fax:281-597-0262
Practice Address - Street 1:7111 HARWIN DR
Practice Address - Street 2:SUITE# 277
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2129
Practice Address - Country:US
Practice Address - Phone:832-382-3422
Practice Address - Fax:281-597-0262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THREE ANGELS MEDICAL CLINIC INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7033345163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Multi-Specialty