Provider Demographics
NPI:1407256472
Name:CORNERSTONE FAMILY HEALTH CENTER PLLC
Entity type:Organization
Organization Name:CORNERSTONE FAMILY HEALTH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOBOLANLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGBEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, RN, FNP-C
Authorized Official - Phone:409-225-5644
Mailing Address - Street 1:PO BOX 20303
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77720-0303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6340 ELLINGTON LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-4044
Practice Address - Country:US
Practice Address - Phone:409-225-5644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671760261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care