Centrum Medical Holdings of Texas, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

CENTRUM MEDICAL HOLDINGS OF TEXAS, LLC

Practice address

1463 S Mason Rd
Katy, TX 77450-4568

Phone

(305) 266-2929

Fax

(786) 558-0242

NPI assigned

Aug 17, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Graciela Vanessa Victorero

Title

Coo

Phone

(305) 266-2929

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629158400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1942976360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5730 SW 74TH ST STE 200",
            "city": "SOUTH MIAMI",
            "state": "FL",
            "postal_code": "331435300",
            "telephone_number": "305-266-2929",
            "fax_number": "786-558-0242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1463 S MASON RD",
            "city": "KATY",
            "state": "TX",
            "postal_code": "774504568",
            "telephone_number": "305-266-2929",
            "fax_number": "786-558-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRUM MEDICAL HOLDINGS OF TEXAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-17",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A",
        "authorized_official_last_name": "VICTORERO",
        "authorized_official_first_name": "GRACIELA",
        "authorized_official_middle_name": "VANESSA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "305-266-2929"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Katy, TX
• Providers in Katy, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.