Provider Demographics
NPI:1336964204
Name:TEJANO MEDICAL CLINIC PLLC
Entity type:Organization
Organization Name:TEJANO MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:832-317-5351
Mailing Address - Street 1:6903 DU BOISE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-1607
Mailing Address - Country:US
Mailing Address - Phone:832-317-5351
Mailing Address - Fax:
Practice Address - Street 1:5608 PINEMONT DR STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-2622
Practice Address - Country:US
Practice Address - Phone:832-317-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care