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NPI Code Detail

MEDICARE: LA MANSION INTERESTS INC

MEDICARE: LA MANSION INTERESTS INC
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1780992925
Entity Type Code : Organization
Provider Name (Legal Business Name) : LA MANSION INTERESTS INC
Provider Business Mailing Address
First Line : 2620 TANGLEWILDE ST
Second Line :
City : HOUSTON
State : TX
Zip : 77063-3203
Country : US
Telephone Number : 713-860-8383
Fax Number : 713-860-8384
Provider Business Practice Location Address
First Line : 2620 TANGLEWILDE ST
Second Line :
City : HOUSTON
State : TX
Zip : 77063-3203
Country : US
Telephone Number : 713-860-8383
Fax Number : 713-860-8384
Authorized Official
Title or Position : CEO
Name : ZAHRA LILLIE TAAT
Credential :
Telephone Number : 713-860-8383
Provider Enumeration Date : 09/22/2010
Last Update Date : 10/03/2011

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