Provider Demographics
NPI:1710227442
Name:POLICLINICA SALUD Y VIDA
Entity Type:Organization
Organization Name:POLICLINICA SALUD Y VIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELIZALDE GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-975-8601
Mailing Address - Street 1:6633 HILLCROFT ST
Mailing Address - Street 2:SUITE 261
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4887
Mailing Address - Country:US
Mailing Address - Phone:281-975-8601
Mailing Address - Fax:
Practice Address - Street 1:6633 HILLCROFT ST
Practice Address - Street 2:SUITE 261
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4887
Practice Address - Country:US
Practice Address - Phone:281-975-8601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service