Healthcare Provider Details

I. General information

NPI: 1467924100
Provider Name (Legal Business Name): BRIAN EXCEUS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 SPACE CENTER BLVD
PASADENA TX
77505-3966
US

IV. Provider business mailing address

15902 HIGHWAY 3 APT 2014
WEBSTER TX
77598-6101
US

V. Phone/Fax

Practice location:
  • Phone: 713-575-1800
  • Fax:
Mailing address:
  • Phone: 786-391-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number213142
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: