Provider Demographics
NPI:1063917896
Name:PANAMERICANA FAMILY MEDICINE CLINIC PLLC
Entity type:Organization
Organization Name:PANAMERICANA FAMILY MEDICINE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:713-480-9129
Mailing Address - Street 1:7126 RANCHERIA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-4330
Mailing Address - Country:US
Mailing Address - Phone:713-240-1221
Mailing Address - Fax:
Practice Address - Street 1:1900 BLALOCK RD # 1900M
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-5450
Practice Address - Country:US
Practice Address - Phone:713-480-9129
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty