Provider Demographics
NPI: | 1245571991 |
---|---|
Name: | HOUSTONOG PLLC. |
Entity Type: | Organization |
Organization Name: | HOUSTONOG PLLC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LUIS |
Authorized Official - Middle Name: | ARTURO |
Authorized Official - Last Name: | SANDOVAL-MARTINEZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 713-775-1017 |
Mailing Address - Street 1: | 1200 POST OAK BLVD APT 2803 |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77056-3266 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-775-1017 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2050 NORTH LOOP W STE 224 |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77018-8115 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-668-0720 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-03-05 |
Last Update Date: | 2013-03-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | N1126 | 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Single Specialty |