Provider Demographics
NPI:1710436498
Name:HOUSTON CRANIOFACIAL & SINUS IMAGING LL C
Entity Type:Organization
Organization Name:HOUSTON CRANIOFACIAL & SINUS IMAGING LL C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BOUTROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-791-0700
Mailing Address - Street 1:9230 KATY FREEWAY, SUITE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055
Mailing Address - Country:US
Mailing Address - Phone:713-791-0700
Mailing Address - Fax:
Practice Address - Street 1:9230 KATY FREEWAY, SUITE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055
Practice Address - Country:US
Practice Address - Phone:713-791-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology