Provider Demographics
NPI:1578148102
Name:AMADO HOLISTIC PLLC
Entity Type:Organization
Organization Name:AMADO HOLISTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MILENA
Authorized Official - Last Name:AMADO MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-228-2005
Mailing Address - Street 1:27910 STARLIGHT HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1702
Mailing Address - Country:US
Mailing Address - Phone:832-228-2005
Mailing Address - Fax:
Practice Address - Street 1:1259 FM 1463 RD STE 400
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5480
Practice Address - Country:US
Practice Address - Phone:832-228-2005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty