Healthcare Provider Details

I. General information

NPI: 1053933630
Provider Name (Legal Business Name): JZB ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 05/17/2020
Certification Date: 05/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 20TH AVE S APT 1711
NASHVILLE TN
37203-3992
US

IV. Provider business mailing address

905 20TH AVE S APT 1711
NASHVILLE TN
37203-3992
US

V. Phone/Fax

Practice location:
  • Phone: 409-206-0490
  • Fax:
Mailing address:
  • Phone: 409-206-0490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MANUEL LOZADA
Title or Position: PRESIDENT/CEO
Credential:
Phone: 615-322-8476