Provider Demographics
NPI:1427255223
Name:BOSQUES, GLENDALIZ (MD)
Entity type:Individual
Prefix:
First Name:GLENDALIZ
Middle Name:
Last Name:BOSQUES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200903
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0903
Mailing Address - Country:US
Mailing Address - Phone:281-252-9993
Mailing Address - Fax:281-252-9997
Practice Address - Street 1:1333 MOURSUND ST # E105
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3405
Practice Address - Country:US
Practice Address - Phone:713-799-5071
Practice Address - Fax:713-799-5095
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00691712081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine