Healthcare Provider Details

I. General information

NPI: 1205189198
Provider Name (Legal Business Name): JNJM ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 STAGG DR SUITE 100
BEAUMONT TX
77701-4521
US

IV. Provider business mailing address

PO BOX 1983
LEAGUE CITY TX
77574-1983
US

V. Phone/Fax

Practice location:
  • Phone: 281-684-8535
  • Fax: 281-647-0649
Mailing address:
  • Phone: 281-684-8535
  • Fax: 281-647-0649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MONAL JANAK PATEL
Title or Position: CLINIC MANAGER
Credential: MHA, MBA
Phone: 281-684-8535