Provider Demographics
NPI:1316182496
Name:TEXAS VACCINE INSTITUTE CO.
Entity Type:Organization
Organization Name:TEXAS VACCINE INSTITUTE CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:DE ANGULO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-828-1893
Mailing Address - Street 1:5210 MAYBROOK PARK LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8084
Mailing Address - Country:US
Mailing Address - Phone:281-828-1893
Mailing Address - Fax:281-828-1893
Practice Address - Street 1:5210 MAYBROOK PARK LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8084
Practice Address - Country:US
Practice Address - Phone:281-828-1893
Practice Address - Fax:281-828-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2009-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty