Provider Demographics
NPI:1225117872
Name:CAPITOL MEDICAL MANAGEMENT GROUP
Entity Type:Organization
Organization Name:CAPITOL MEDICAL MANAGEMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZALDUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-335-2371
Mailing Address - Street 1:PO BOX 4897
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4897
Mailing Address - Country:US
Mailing Address - Phone:713-335-2365
Mailing Address - Fax:713-328-0796
Practice Address - Street 1:7505 S. MAIN ST STE# 520
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4540
Practice Address - Country:US
Practice Address - Phone:713-335-2365
Practice Address - Fax:713-328-0796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00203WMedicare PIN