Provider Demographics
NPI:1477944833
Name:CLINICA SAN DANIEL
Entity Type:Organization
Organization Name:CLINICA SAN DANIEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANJUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-481-0770
Mailing Address - Street 1:10904 SCARSDALE BLVD STE 275
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6035
Mailing Address - Country:US
Mailing Address - Phone:281-481-0770
Mailing Address - Fax:281-481-0706
Practice Address - Street 1:10904 SCARSDALE BLVD STE 275
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6035
Practice Address - Country:US
Practice Address - Phone:281-481-0770
Practice Address - Fax:281-481-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1754261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center