Provider Demographics
NPI:1700582863
Name:EXCEPTIONAL CARE ELITE PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:EXCEPTIONAL CARE ELITE PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LATASHIA
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-277-5843
Mailing Address - Street 1:400 N SAM HOUSTON PKWY E STE 280
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3548
Mailing Address - Country:US
Mailing Address - Phone:832-277-5843
Mailing Address - Fax:
Practice Address - Street 1:400 N SAM HOUSTON PKWY E STE 280
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3548
Practice Address - Country:US
Practice Address - Phone:832-277-5843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty