Provider Demographics
NPI:1639548977
Name:CLINICA MANAGEMENT GROUP INC
Entity Type:Organization
Organization Name:CLINICA MANAGEMENT GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-373-1609
Mailing Address - Street 1:5727 RAMPART ST
Mailing Address - Street 2:A-4
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-2438
Mailing Address - Country:US
Mailing Address - Phone:713-373-1609
Mailing Address - Fax:
Practice Address - Street 1:5727 RAMPART ST
Practice Address - Street 2:A-4
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-2438
Practice Address - Country:US
Practice Address - Phone:713-373-1609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center