Provider Demographics
NPI:1750674321
Name:SAN JOSE CLINIC
Entity Type:Organization
Organization Name:SAN JOSE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:MELCHOR-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-228-9411
Mailing Address - Street 1:2615 FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-9224
Mailing Address - Country:US
Mailing Address - Phone:713-228-9411
Mailing Address - Fax:713-228-2612
Practice Address - Street 1:2615 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9224
Practice Address - Country:US
Practice Address - Phone:713-228-9411
Practice Address - Fax:713-228-2612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health