MEDICARE: LASONJA MALONE CCMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171400000X	Health & Wellness Coach
2	171W00000X	Contractor
3	374U00000X	Home Health Aide
4	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1366970394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LASONJA MALONE CCMA

Provider Business Mailing Address
First Line	:	1880 S DAIRY ASHFORD RD STE 207-439
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-4760
Country	:	US
Telephone Number	:	877-768-4897
Fax Number	:	877-768-4897

Provider Business Practice Location Address
First Line	:	1880 S DAIRY ASHFORD RD STE 207-439
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-4760
Country	:	US
Telephone Number	:	877-768-4897
Fax Number	:	877-768-4897

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2017
Last Update Date	:	05/28/2024

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Directions to “ LASONJA MALONE CCMA” Practice Location

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