Provider Demographics
NPI:1639407067
Name:CARDIOVASCULAR ASSOCIATES OF CLEAR LAKE, P.A.
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF CLEAR LAKE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-557-1215
Mailing Address - Street 1:250 BLOSSOM ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4204
Mailing Address - Country:US
Mailing Address - Phone:281-557-1215
Mailing Address - Fax:281-557-1376
Practice Address - Street 1:250 BLOSSOM ST
Practice Address - Street 2:SUITE 130
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4204
Practice Address - Country:US
Practice Address - Phone:281-557-1215
Practice Address - Fax:281-557-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMPORARY207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty