Healthcare Provider Details

I. General information

NPI: 1669112025
Provider Name (Legal Business Name): NEMT MALEXIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 BISSONNET ST STE 460E
HOUSTON TX
77074-3914
US

IV. Provider business mailing address

7455 AVALON TRCE
RICHMOND TX
77407-4487
US

V. Phone/Fax

Practice location:
  • Phone: 713-391-5035
  • Fax:
Mailing address:
  • Phone: 713-391-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: NAOMIN MBIANGO YAWELI
Title or Position: SUPERVISOR
Credential:
Phone: 713-391-5035