Provider Demographics
NPI:1477910891
Name:CLINICA KLASSICA MEDICINA INC
Entity type:Organization
Organization Name:CLINICA KLASSICA MEDICINA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NDUBUISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-879-2443
Mailing Address - Street 1:5101 HARRISBURG BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011-4227
Mailing Address - Country:US
Mailing Address - Phone:832-879-2443
Mailing Address - Fax:832-879-2439
Practice Address - Street 1:5101 HARRISBURG BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011-4227
Practice Address - Country:US
Practice Address - Phone:832-879-2443
Practice Address - Fax:832-879-2439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities