Provider Demographics
NPI:1356668750
Name:UNIVERSAL HEALTHCARE WELLNESS AND DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:UNIVERSAL HEALTHCARE WELLNESS AND DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERRIE
Authorized Official - Middle Name:ESTELLA
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-322-4949
Mailing Address - Street 1:4141 SW FWY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7313
Mailing Address - Country:US
Mailing Address - Phone:713-621-0003
Mailing Address - Fax:713-621-3339
Practice Address - Street 1:4141 SW FWY
Practice Address - Street 2:SUITE 225
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7313
Practice Address - Country:US
Practice Address - Phone:713-621-0003
Practice Address - Fax:713-621-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8518200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1194857821OtherREGISTERED NURSE
TX1356674550OtherCNA