Provider Demographics
NPI:1427597046
Name:CLINIC 59
Entity Type:Organization
Organization Name:CLINIC 59
Other - Org Name:CLINIC 59
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-777-6650
Mailing Address - Street 1:19333 HIGHWAY 59 N STE 225
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4284
Mailing Address - Country:US
Mailing Address - Phone:832-777-6650
Mailing Address - Fax:832-777-6694
Practice Address - Street 1:19333 HIGHWAY 59 N STE 225
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4284
Practice Address - Country:US
Practice Address - Phone:832-777-6650
Practice Address - Fax:832-777-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty