| Centrum Medical Group, Pllc | |
|
1463 S Mason Rd Katy TX 77450-4568 | |
| (305) 266-2929 | |
| (786) 558-0242 |
| Full Name | Centrum Medical Group, Pllc |
|---|---|
| Speciality | General Practice |
| Location | 1463 S Mason Rd, Katy, Texas |
| Authorized Official Name and Position | Graciela Vanessa Victorero (COO) |
| Authorized Official Contact | 3052662929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centrum Medical Group, Pllc 9250 Nw 36th St Ste 420 Doral FL 33178-2775 Ph: (305) 266-2929 | Centrum Medical Group, Pllc 1463 S Mason Rd Katy TX 77450-4568 Ph: (305) 266-2929 |
| NPI Number | 1376219543 |
|---|---|
| Provider Enumeration Date | 08/18/2021 |
| Last Update Date | 01/27/2022 |
| Medicare PECOS PAC ID | 9234500984 |
|---|---|
| Medicare Enrollment ID | O20230117002598 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376219543 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Rosemary O Obudulu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740215029 PECOS PAC ID: 9830289776 Enrollment ID: I20071217000186 |
| Provider Name | Guocheng D He |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1255661971 PECOS PAC ID: 0547416125 Enrollment ID: I20120814000643 |
| Provider Name | Wendyann J Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336564293 PECOS PAC ID: 6709007370 Enrollment ID: I20141023001419 |
| Provider Name | Ayesha S Khan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154578243 PECOS PAC ID: 7012068877 Enrollment ID: I20170315001968 |
| Provider Name | Dara B Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912484932 PECOS PAC ID: 9133464290 Enrollment ID: I20181218000483 |
| Provider Name | Mahwish Y Ilyas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982869293 PECOS PAC ID: 3476710112 Enrollment ID: I20190311001926 |
| Provider Name | Mohamed Mansour |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1871809442 PECOS PAC ID: 7113144833 Enrollment ID: I20200325000741 |
| Provider Name | Conceptah Luchendo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275147944 PECOS PAC ID: 4880005289 Enrollment ID: I20201116000667 |
| Provider Name | Egodi Agatha Onuoha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316550239 PECOS PAC ID: 4587079199 Enrollment ID: I20210212000284 |
| Provider Name | Meriam S Ahmed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609426733 PECOS PAC ID: 4587060207 Enrollment ID: I20210903002358 |
| Provider Name | Ma Kristina Rejuso-hsu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033756481 PECOS PAC ID: 0143626408 Enrollment ID: I20210913000193 |
| Provider Name | Dairon M Garcia Aguilera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891380689 PECOS PAC ID: 6800294034 Enrollment ID: I20211001001731 |
| Provider Name | Saira Bari Anwar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609337583 PECOS PAC ID: 5294108239 Enrollment ID: I20230222001948 |
| Provider Name | Krystal Outlaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831715614 PECOS PAC ID: 4183099054 Enrollment ID: I20230406000023 |
| Provider Name | Charles Misori |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629171293 PECOS PAC ID: 6709885338 Enrollment ID: I20230716000132 |
| Provider Name | Akhi Saha |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1841650041 PECOS PAC ID: 2567897184 Enrollment ID: I20230802001175 |
| Provider Name | Dinah A Obere |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538733837 PECOS PAC ID: 4183085269 Enrollment ID: I20230806000048 |
| Provider Name | Yanique Cummings-miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023779428 PECOS PAC ID: 1254793144 Enrollment ID: I20230809001089 |
| Provider Name | Paulina Acquaye |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902573066 PECOS PAC ID: 7719349497 Enrollment ID: I20230811001425 |
| Provider Name | Loise U Ekwem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053892240 PECOS PAC ID: 8729440474 Enrollment ID: I20230814001156 |
| Provider Name | Sachi Chandran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609345966 PECOS PAC ID: 4789046293 Enrollment ID: I20230816000373 |
| Provider Name | Smitha Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649859471 PECOS PAC ID: 4880056035 Enrollment ID: I20230821000130 |
| Provider Name | Valerie Nana Gyebi-antwi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306508072 PECOS PAC ID: 2567825805 Enrollment ID: I20230901003471 |
| Provider Name | Elizabeth Kaluanya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851814131 PECOS PAC ID: 7517321979 Enrollment ID: I20230919000436 |
| Provider Name | Minimol Mathew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437743424 PECOS PAC ID: 2860856184 Enrollment ID: I20230919003478 |
| Provider Name | Nathaly Vega Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730813734 PECOS PAC ID: 2062857790 Enrollment ID: I20240304001875 |
| Provider Name | Samuel Machuca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801597372 PECOS PAC ID: 5395180061 Enrollment ID: I20240304003311 |
| Provider Name | Clerisse Ewelike |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588122378 PECOS PAC ID: 6103262662 Enrollment ID: I20240307001028 |
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