Provider Demographics
NPI:1982435616
Name:POORVI SANDESARA
Entity type:Organization
Organization Name:POORVI SANDESARA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:POORVI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDESARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:281-701-5956
Mailing Address - Street 1:17515 SPRING CYPRESS RD STE C153
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12941 NORTH FWY STE 216
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-1241
Practice Address - Country:US
Practice Address - Phone:281-919-1095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center