Provider Demographics
NPI:1164592762
Name:UTMB REGIONAL MATERNAL AND CHILD HEALTH PROGRAM
Entity Type:Organization
Organization Name:UTMB REGIONAL MATERNAL AND CHILD HEALTH PROGRAM
Other - Org Name:UTMB RMCHP - PEARLAND
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR, CLINICAL SUPPORT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-772-7725
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:ROUTE - 1078
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1078
Mailing Address - Country:US
Mailing Address - Phone:409-772-7725
Mailing Address - Fax:409-772-7726
Practice Address - Street 1:4616 BROADWAY ST
Practice Address - Street 2:STE. F
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-3956
Practice Address - Country:US
Practice Address - Phone:281-485-3220
Practice Address - Fax:281-485-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty