Provider Demographics
NPI:1447503172
Name:INTERNAL MEDICINE CLINIC
Entity type:Organization
Organization Name:INTERNAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ANGELES
Authorized Official - Middle Name:
Authorized Official - Last Name:SIA-ZAYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-947-9408
Mailing Address - Street 1:2843 MARTINA DR.
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546
Mailing Address - Country:US
Mailing Address - Phone:713-594-5595
Mailing Address - Fax:
Practice Address - Street 1:2843 MARTINA DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5018
Practice Address - Country:US
Practice Address - Phone:713-594-5595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX720463261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care