Provider Demographics
NPI:1346875929
Name:ALTMEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:ALTMEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:346-410-5465
Mailing Address - Street 1:10739 GULF FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-1857
Mailing Address - Country:US
Mailing Address - Phone:346-410-5465
Mailing Address - Fax:346-410-5466
Practice Address - Street 1:10739 GULF FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77034-1857
Practice Address - Country:US
Practice Address - Phone:346-410-5465
Practice Address - Fax:346-410-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty