Healthcare Provider Details

I. General information

NPI: 1972789618
Provider Name (Legal Business Name): ROMANDA DENISE JEFFERSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROMANDA DENISE HUTSELL DO

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22422 BRIDGEHAVEN DR
KATY TX
77494-2218
US

IV. Provider business mailing address

22422 BRIDGEHAVEN DR
KATY TX
77494-2218
US

V. Phone/Fax

Practice location:
  • Phone: 281-392-1809
  • Fax:
Mailing address:
  • Phone: 281-392-1809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL4457
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: