Healthcare Provider Details

I. General information

NPI: 1275303208
Provider Name (Legal Business Name): CAPRICE CUDJOE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14530 ROUNDSTONE LN
HOUSTON TX
77015-2551
US

IV. Provider business mailing address

15335 ORDIC RUN DR.
HUMBLE TX
77346
US

V. Phone/Fax

Practice location:
  • Phone: 630-362-2425
  • Fax:
Mailing address:
  • Phone: 630-362-2425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: