Provider Demographics
NPI:1467192922
Name:CLINICA FAMILIA UNIVERSAL
Entity Type:Organization
Organization Name:CLINICA FAMILIA UNIVERSAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GONGAR ESCOBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-466-3237
Mailing Address - Street 1:2506 W MOUNT HOUSTON RD STE H-1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77038
Mailing Address - Country:US
Mailing Address - Phone:281-847-1133
Mailing Address - Fax:
Practice Address - Street 1:2506 W MOUNT HOUSTON RD STE H-1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77038
Practice Address - Country:US
Practice Address - Phone:281-847-1133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center