Provider Demographics
NPI:1952718470
Name:CLINICA HISPANA CE KING
Entity Type:Organization
Organization Name:CLINICA HISPANA CE KING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-459-9947
Mailing Address - Street 1:8514 CE KING PKWY
Mailing Address - Street 2:SUITE M
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044
Mailing Address - Country:US
Mailing Address - Phone:281-459-9947
Mailing Address - Fax:
Practice Address - Street 1:8514 C E KING PKWY
Practice Address - Street 2:SUITE M
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-2344
Practice Address - Country:US
Practice Address - Phone:281-459-9947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty