Basic Information
| Provider Information | |||||||||
| NPI: | 1235894569 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONNECT PRIMARY CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4619 EVERGREEN ST | ||||||||
| Address2: | |||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774015113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134647555 | ||||||||
| FaxNumber: | 8323081272 | ||||||||
| Practice Location | |||||||||
| Address1: | 6300 WEST LOOP S STE 300 | ||||||||
| Address2: | |||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774012913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134647555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2021 | ||||||||
| LastUpdateDate: | 06/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | LATIF | ||||||||
| AuthorizedOfficialFirstName: | PERNIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 7134647555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.