Provider Demographics
NPI:1699227264
Name:COMMUNITY HEP C CLINIC
Entity type:Organization
Organization Name:COMMUNITY HEP C CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-831-7770
Mailing Address - Street 1:7700 MAIN ST
Mailing Address - Street 2:400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4456
Mailing Address - Country:US
Mailing Address - Phone:832-831-7770
Mailing Address - Fax:713-661-4828
Practice Address - Street 1:7700 MAIN ST
Practice Address - Street 2:400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4456
Practice Address - Country:US
Practice Address - Phone:832-831-7770
Practice Address - Fax:713-661-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3377207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty