Healthcare Provider Details

I. General information

NPI: 1588808133
Provider Name (Legal Business Name): KEISHA LIL ZAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 EASTHAVEN DR 153
PASADENA TX
77506-5173
US

IV. Provider business mailing address

2112 EASTHAVEN DR 153
PASADENA TX
77506-5173
US

V. Phone/Fax

Practice location:
  • Phone: 832-228-7359
  • Fax: 281-334-9298
Mailing address:
  • Phone: 832-228-7359
  • Fax: 281-334-9298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: