Provider Demographics
NPI:1922735828
Name:UPDATE FAMILY CLINIC LLC
Entity Type:Organization
Organization Name:UPDATE FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUDIRAT
Authorized Official - Middle Name:F
Authorized Official - Last Name:SUNMONU
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN
Authorized Official - Phone:832-563-4254
Mailing Address - Street 1:1811 AVENUE H
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2627
Mailing Address - Country:US
Mailing Address - Phone:832-563-4254
Mailing Address - Fax:
Practice Address - Street 1:1811 AVENUE H
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2627
Practice Address - Country:US
Practice Address - Phone:832-563-4254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty