Provider Demographics
NPI:1790102994
Name:MEDLOSS
Entity Type:Organization
Organization Name:MEDLOSS
Other - Org Name:HILCROFT PM CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYORGA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:713-772-5840
Mailing Address - Street 1:6910 BELLAIRE BLVD BLDG STE 8
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3509
Mailing Address - Country:US
Mailing Address - Phone:713-780-8367
Mailing Address - Fax:713-772-5841
Practice Address - Street 1:6910 BELLAIRE BLVD BLDG STE 8
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-3509
Practice Address - Country:US
Practice Address - Phone:713-780-8367
Practice Address - Fax:713-772-5841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3117208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty