Healthcare Provider Details

I. General information

NPI: 1689986911
Provider Name (Legal Business Name): KDP HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11338 SAGE HILL DR
HOUSTON TX
77089-4634
US

IV. Provider business mailing address

11338 SAGEHILL DR
HOUSTON TX
77089-4634
US

V. Phone/Fax

Practice location:
  • Phone: 832-891-4952
  • Fax:
Mailing address:
  • Phone: 832-891-4952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberW13557
License Number StateTX

VIII. Authorized Official

Name: MRS. DAISY EVETTE PETERS
Title or Position: OWER
Credential: 01181967
Phone: 832-891-4952