| Vintage Wellness Clinic | |
|
464 Park Grove Dr Ste B Katy TX 77450-1571 | |
| (832) 449-8411 | |
| Not Available |
| Full Name | Vintage Wellness Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 464 Park Grove Dr Ste B, Katy, Texas |
| Authorized Official Name and Position | Jose Arevalo (NURSE PRACTITIONER/MEDICAL PROVIDER) |
| Authorized Official Contact | 9189789601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vintage Wellness Clinic 464 Park Grove Dr Ste B Katy TX 77450-1571 Ph: (832) 449-8411 | Vintage Wellness Clinic 464 Park Grove Dr Ste B Katy TX 77450-1571 Ph: (832) 449-8411 |
| NPI Number | 1770237620 |
|---|---|
| Provider Enumeration Date | 02/09/2022 |
| Last Update Date | 02/09/2022 |
| Certification Date | 02/09/2022 |
| Medicare PECOS PAC ID | 7113311507 |
|---|---|
| Medicare Enrollment ID | O20220301000999 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770237620 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Jose Alton Arevalo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396189015 PECOS PAC ID: 9133479199 Enrollment ID: I20220301001137 |
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