Healthcare Provider Details

I. General information

NPI: 1528779550
Provider Name (Legal Business Name): PATRICIA BUZOMBO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20320 NORTHWEST FWY STE 400
JERSEY VILLAGE TX
77065
US

IV. Provider business mailing address

20320 NORTHWEST FWY STE 400
JERSEY VILLAGE TX
77065-5643
US

V. Phone/Fax

Practice location:
  • Phone: 346-260-5112
  • Fax: 832-376-7541
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1100722
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: