Provider Demographics
NPI:1891090445
Name:ELLA AFTER HOURS CLINIC, P.C.
Entity Type:Organization
Organization Name:ELLA AFTER HOURS CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORREGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-906-4565
Mailing Address - Street 1:2499 ELLA BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2709
Mailing Address - Country:US
Mailing Address - Phone:713-880-4111
Mailing Address - Fax:713-880-4114
Practice Address - Street 1:2499 ELLA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2709
Practice Address - Country:US
Practice Address - Phone:713-880-4111
Practice Address - Fax:713-880-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty