Basic Information
| Provider Information | |||||||||
| NPI: | 1508801119 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREVENTIVE HEALTH & WELLNESS GROUP, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14219 BRENTSHIRE LN | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770691441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007422368 | ||||||||
| FaxNumber: | 9372912962 | ||||||||
| Practice Location | |||||||||
| Address1: | 14219 BRENTSHIRE LN | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770691441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322496200 | ||||||||
| FaxNumber: | 8322499205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | DEVITA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2814445151 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.