Provider Demographics
NPI:1346514619
Name:PRISTINE OB-GYN CARE PLLC
Entity Type:Organization
Organization Name:PRISTINE OB-GYN CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IYABODE
Authorized Official - Middle Name:MUNIRAT
Authorized Official - Last Name:OGUNLADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-206-4496
Mailing Address - Street 1:13523 HARGRAVE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3829
Mailing Address - Country:US
Mailing Address - Phone:281-206-4496
Mailing Address - Fax:281-206-4487
Practice Address - Street 1:13523 HARGRAVE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3829
Practice Address - Country:US
Practice Address - Phone:281-206-4496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8471261QM2500X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297102001Medicaid
TX411162701Medicaid