Provider Demographics
NPI:1821304155
Name:MINT PHYSICIANS
Entity Type:Organization
Organization Name:MINT PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECRUITER
Authorized Official - Prefix:
Authorized Official - First Name:CANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-541-1177
Mailing Address - Street 1:711 FM 1959 RD APT 903
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-5474
Mailing Address - Country:US
Mailing Address - Phone:281-464-7499
Mailing Address - Fax:
Practice Address - Street 1:10375 RICHMOND AVE STE 1575
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4468
Practice Address - Country:US
Practice Address - Phone:713-541-1177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109104251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare