1194407627 NPI number — CHANTELLE CORINA TORRES GARCIA

Table of content: CHANTELLE CORINA TORRES GARCIA (NPI 1194407627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194407627 NPI number — CHANTELLE CORINA TORRES GARCIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
CHANTELLE CORINA
Provider Middle Name:
TORRES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194407627
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 PINELOCH DR STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77062-2736
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-461-6888
Provider Business Mailing Address Fax Number:
866-237-5824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11240 FM 1960 RD W STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77065-3664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-461-6888
Provider Business Practice Location Address Fax Number:
866-237-5824
Provider Enumeration Date:
08/03/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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