Provider Demographics
NPI:1033426325
Name:SAN JACINTO CLINIC & REHABILITATION LLC
Entity type:Organization
Organization Name:SAN JACINTO CLINIC & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BICHLIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-654-4033
Mailing Address - Street 1:2802 SAN JACINTO ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-2700
Mailing Address - Country:US
Mailing Address - Phone:713-654-4033
Mailing Address - Fax:713-654-4036
Practice Address - Street 1:2802 SAN JACINTO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-2700
Practice Address - Country:US
Practice Address - Phone:713-654-4033
Practice Address - Fax:713-654-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3173225CX0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training ProviderGroup - Multi-Specialty