Healthcare Provider Details

I. General information

NPI: 1467118877
Provider Name (Legal Business Name): NLUC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2021
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 GATTIS SCHOOL RD
ROUND ROCK TX
78664-9777
US

IV. Provider business mailing address

2925 BRIARPARK DR STE 575
HOUSTON TX
77042-3776
US

V. Phone/Fax

Practice location:
  • Phone: 281-783-8162
  • Fax:
Mailing address:
  • Phone: 281-783-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIET S BREEZE
Title or Position: CEO
Credential:
Phone: 281-201-0657