Provider Demographics
NPI:1205907987
Name:FAMILY TREE HEALTH CLINIC P A
Entity type:Organization
Organization Name:FAMILY TREE HEALTH CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:FRANCISCO
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-538-8188
Mailing Address - Street 1:2911 S SHORE BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3922
Mailing Address - Country:US
Mailing Address - Phone:281-538-8188
Mailing Address - Fax:281-538-8189
Practice Address - Street 1:2911 S SHORE BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3922
Practice Address - Country:US
Practice Address - Phone:281-538-8188
Practice Address - Fax:281-538-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDTXJ9936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0042LWOtherBLUE CROSS BLUE SHIELD
TX177836701Medicaid
TX00265XMedicare PIN
TX177836701Medicaid