1669612040 NPI number — ANNA MARIA BUENAVENTURA AND ANAND BALASUBRAMANIAN LLC

Table of content: (NPI 1669612040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669612040 NPI number — ANNA MARIA BUENAVENTURA AND ANAND BALASUBRAMANIAN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNA MARIA BUENAVENTURA AND ANAND BALASUBRAMANIAN LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1669612040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17030 NANES DR
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:
77090-2503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-893-8100
Provider Business Mailing Address Fax Number:
281-271-8457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17030 NANES DR
Provider Second Line Business Practice Location Address:
SUITE106
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77090-2503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-893-8100
Provider Business Practice Location Address Fax Number:
281-271-8457
Provider Enumeration Date:
02/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BUENAVENTURA
Authorized Official First Name:
ANAND
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
281-839-8100

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  LA271 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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