Provider Demographics
NPI:1831628874
Name:BROOKHOLLOW OB & GYN CLINIC, PLLC
Entity type:Organization
Organization Name:BROOKHOLLOW OB & GYN CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D J
Authorized Official - Last Name:AVALOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-622-2059
Mailing Address - Street 1:14990 NORTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-4025
Mailing Address - Country:US
Mailing Address - Phone:832-230-1803
Mailing Address - Fax:832-240-3402
Practice Address - Street 1:14990 NORTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-4025
Practice Address - Country:US
Practice Address - Phone:832-230-1803
Practice Address - Fax:832-240-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-04
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7526207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty