Provider Demographics
NPI:1659137073
Name:THRIVE IV THERAPY AND HOLISTIC CLINIC
Entity Type:Organization
Organization Name:THRIVE IV THERAPY AND HOLISTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ PORTO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:831-793-7158
Mailing Address - Street 1:11819 PINEY BEND DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-7501
Mailing Address - Country:US
Mailing Address - Phone:831-793-7158
Mailing Address - Fax:
Practice Address - Street 1:7095 A HWY 6
Practice Address - Street 2:HOUSTON
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:281-662-3197
Practice Address - Fax:361-248-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty