Provider Demographics
NPI:1437398369
Name:LOURDES R. BOSQUEZ, M.D., P.A.
Entity Type:Organization
Organization Name:LOURDES R. BOSQUEZ, M.D., P.A.
Other - Org Name:LOURDES R. BOSQUEZ, M.D., P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:RAMIREZ
Authorized Official - Last Name:BOSQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-364-9884
Mailing Address - Street 1:9006 FOREST XING STE C
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1155
Mailing Address - Country:US
Mailing Address - Phone:281-364-9884
Mailing Address - Fax:281-364-7747
Practice Address - Street 1:9006 FOREST XING STE C
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1155
Practice Address - Country:US
Practice Address - Phone:281-364-9884
Practice Address - Fax:281-364-7747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK24222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00016BP7Medicaid
TX0016BPOtherMEDICARE
TXG47227Medicare UPIN