Healthcare Provider Details

I. General information

NPI: 1285299677
Provider Name (Legal Business Name): ESSENCE RENAE MOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9734 W MONTGOMERY RD
HOUSTON TX
77088-4600
US

IV. Provider business mailing address

5630 LONGFOREST DR
HOUSTON TX
77088-1240
US

V. Phone/Fax

Practice location:
  • Phone: 844-320-2157
  • Fax:
Mailing address:
  • Phone: 713-320-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: