Provider Demographics
NPI:1225286305
Name:BELLAIRE WELLNESS MANAGEMENT INC
Entity Type:Organization
Organization Name:BELLAIRE WELLNESS MANAGEMENT INC
Other - Org Name:BELLAIRE WELLNESS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ- CANCEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-339-1566
Mailing Address - Street 1:5611 BELLAIRE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5630
Mailing Address - Country:US
Mailing Address - Phone:713-339-1566
Mailing Address - Fax:713-339-1518
Practice Address - Street 1:5611 BELLAIRE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5630
Practice Address - Country:US
Practice Address - Phone:713-339-1566
Practice Address - Fax:713-339-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7582174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty