Provider Demographics
NPI:1750751160
Name:CLINICA UNIVERSO LATINO 1 LLC
Entity type:Organization
Organization Name:CLINICA UNIVERSO LATINO 1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-437-4883
Mailing Address - Street 1:5650 ROBERTS RD BLDG B
Mailing Address - Street 2:300
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1305
Mailing Address - Country:US
Mailing Address - Phone:832-437-4883
Mailing Address - Fax:281-665-7068
Practice Address - Street 1:5650 ROBERTS RD BLDG B
Practice Address - Street 2:300
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1305
Practice Address - Country:US
Practice Address - Phone:832-437-4883
Practice Address - Fax:281-665-7068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center