Provider Demographics
NPI:1790316370
Name:BRAMBILA, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:BRAMBILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 SPRING GREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6910
Mailing Address - Country:US
Mailing Address - Phone:281-769-4361
Mailing Address - Fax:281-769-4362
Practice Address - Street 1:1712 SPRING GREEN BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6910
Practice Address - Country:US
Practice Address - Phone:281-769-4362
Practice Address - Fax:281-769-4362
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567251835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist