Provider Demographics
NPI:1811153349
Name:WELLBOUND OF HOUSTON LLC
Entity type:Organization
Organization Name:WELLBOUND OF HOUSTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE & RISK DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-404-3771
Mailing Address - Street 1:300 SANTANA ROW STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2424
Mailing Address - Country:US
Mailing Address - Phone:650-404-3600
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:12176 N MO PAC EXPY
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2908
Practice Address - Country:US
Practice Address - Phone:512-833-6695
Practice Address - Fax:512-833-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2020-05-15
Deactivation Date:2020-05-04
Deactivation Code:
Reactivation Date:2020-05-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110006Medicaid
TX672651Medicare Oscar/Certification