Provider Demographics
NPI:1346605334
Name:BAYLOR CULLEN TEEN HEALTH
Entity Type:Organization
Organization Name:BAYLOR CULLEN TEEN HEALTH
Other - Org Name:BAYLOR TEEN CLINIC-CULLEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.N.
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-440-7313
Mailing Address - Street 1:1504 TAUB LOOP # 1A29
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1608
Mailing Address - Country:US
Mailing Address - Phone:713-440-7313
Mailing Address - Fax:713-440-9238
Practice Address - Street 1:5737 CULLEN BLVD # 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-1665
Practice Address - Country:US
Practice Address - Phone:713-440-7313
Practice Address - Fax:713-440-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20525333600000X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2155998OtherPK