Provider Demographics
NPI:1851838239
Name:CLINICA FAMILIAR BELLAIRE
Entity Type:Organization
Organization Name:CLINICA FAMILIAR BELLAIRE
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-671-9398
Mailing Address - Street 1:5727 BELLAIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5505
Mailing Address - Country:US
Mailing Address - Phone:936-671-9398
Mailing Address - Fax:713-664-8300
Practice Address - Street 1:5727 BELLAIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5505
Practice Address - Country:US
Practice Address - Phone:936-671-9398
Practice Address - Fax:713-664-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0005X261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility