Healthcare Provider Details

I. General information

NPI: 1962771766
Provider Name (Legal Business Name): JENNIFER IRENE HAMOUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18945 FM 2252 STE 115
GARDEN RIDGE TX
78266-2797
US

IV. Provider business mailing address

10418 LAKE BREEZE DR
SPRING VALLEY CA
91977-3471
US

V. Phone/Fax

Practice location:
  • Phone: 866-595-6379
  • Fax: 210-651-0029
Mailing address:
  • Phone: 209-481-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: