Provider Demographics
NPI:1548538531
Name:EL CENTRO DE CORAZON
Entity type:Organization
Organization Name:EL CENTRO DE CORAZON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-1880
Mailing Address - Street 1:5001 NAVIGATION BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011-1019
Mailing Address - Country:US
Mailing Address - Phone:713-926-1849
Mailing Address - Fax:713-926-4244
Practice Address - Street 1:5901 LONG DR STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-1003
Practice Address - Country:US
Practice Address - Phone:713-660-1880
Practice Address - Fax:713-926-9105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL CENTRO DE CORAZON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-06
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)