Provider Demographics
NPI:1942976360
Name:CENTRUM MEDICAL HOLDINGS OF TEXAS, LLC
Entity Type:Organization
Organization Name:CENTRUM MEDICAL HOLDINGS OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:VANESSA
Authorized Official - Last Name:VICTORERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-266-2929
Mailing Address - Street 1:5730 SW 74TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5300
Mailing Address - Country:US
Mailing Address - Phone:305-266-2929
Mailing Address - Fax:786-558-0242
Practice Address - Street 1:1463 S MASON RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-4568
Practice Address - Country:US
Practice Address - Phone:305-266-2929
Practice Address - Fax:786-558-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty