Healthcare Provider Details

I. General information

NPI: 1841748092
Provider Name (Legal Business Name): ANOTHER VICTORIOUS INDIVIDUAL PROSPERING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 GARDEN LAND CT
HOUSTON TX
77073-5540
US

IV. Provider business mailing address

918 GARDEN LAND CT
HOUSTON TX
77073-5540
US

V. Phone/Fax

Practice location:
  • Phone: 832-282-3493
  • Fax: 281-982-3768
Mailing address:
  • Phone: 832-282-3493
  • Fax: 281-982-3768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA D JONES
Title or Position: OWNER/SUPERVISOR
Credential:
Phone: 832-282-3493