Provider Demographics
NPI:1124722905
Name:SAN GABRIEL PRIMARY CARE AND ASSOCIATES LLC
Entity type:Organization
Organization Name:SAN GABRIEL PRIMARY CARE AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:I
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-447-1375
Mailing Address - Street 1:11012 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-1112
Mailing Address - Country:US
Mailing Address - Phone:713-447-1375
Mailing Address - Fax:281-667-3275
Practice Address - Street 1:15127 DRAPER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1413
Practice Address - Country:US
Practice Address - Phone:713-447-1375
Practice Address - Fax:281-667-3275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty