Provider Demographics
NPI:1205015369
Name:OCTAVIO BARRIOS, MD PLLC
Entity Type:Organization
Organization Name:OCTAVIO BARRIOS, MD PLLC
Other - Org Name:RENAISSANCE FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-542-9400
Mailing Address - Street 1:517 W GRAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4476
Mailing Address - Country:US
Mailing Address - Phone:713-942-7546
Mailing Address - Fax:281-542-9461
Practice Address - Street 1:7106 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-1806
Practice Address - Country:US
Practice Address - Phone:281-542-9400
Practice Address - Fax:281-542-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty