Healthcare Provider Details

I. General information

NPI: 1922399856
Provider Name (Legal Business Name): RANDA DJENDOU M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23530 KINGSLAND BLVD STE 130
KATY TX
77494-7466
US

IV. Provider business mailing address

23530 KINGSLAND BLVD STE 130
KATY TX
77494-7466
US

V. Phone/Fax

Practice location:
  • Phone: 832-522-8751
  • Fax: 832-522-8770
Mailing address:
  • Phone: 832-522-8751
  • Fax: 832-522-8770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP9838
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: