Healthcare Provider Details

I. General information

NPI: 1558715219
Provider Name (Legal Business Name): KEZO ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 E ARKANSAS LN SUITE 311
ARLINGTON TX
76010-8797
US

IV. Provider business mailing address

2535 E ARKANSAS LN SUITE 311
ARLINGTON TX
76010-8797
US

V. Phone/Fax

Practice location:
  • Phone: 469-740-9646
  • Fax:
Mailing address:
  • Phone: 469-740-9646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: BABATOPE OMOJOKUN
Title or Position: GENERAL MANAGER
Credential:
Phone: 469-740-9646