| Organization Name: | MANOR FAMILY PRACTICE, PLLC |
| NPI Number: | 1154761559 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARILYN RUIZ (MEMBER) |
| Mailing Address: | 14001 Shadow Glen Blvd Suite G Manor |
| State: | TX US |
| Postal Code: | 786533386 |
| Phone Number: | 5125354787 |
| Fax Number: | |
| NPI Enumeration Date: | 06/28/2013 |
| NPI Last Update Date: | 06/28/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | N0419 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |