Provider Demographics
NPI:1255761326
Name:SANTA CLARA FAMILY CLINIC PLLC
Entity type:Organization
Organization Name:SANTA CLARA FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:MORA AMADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-923-2273
Mailing Address - Street 1:3420 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-3735
Mailing Address - Country:US
Mailing Address - Phone:713-923-2273
Mailing Address - Fax:713-923-2276
Practice Address - Street 1:3420 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-3735
Practice Address - Country:US
Practice Address - Phone:713-923-2273
Practice Address - Fax:713-923-2276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6789208000000X
TXP3934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty