Healthcare Provider Details

I. General information

NPI: 1780614404
Provider Name (Legal Business Name): LUANT&ODERA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 SAWDUST RD
SPRING TX
77380-2242
US

IV. Provider business mailing address

379 SAWDUST RD
SPRING TX
77380-2242
US

V. Phone/Fax

Practice location:
  • Phone: 281-298-4014
  • Fax: 281-298-8028
Mailing address:
  • Phone: 281-298-4014
  • Fax: 281-298-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0065860
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0065860
License Number StateTX

VIII. Authorized Official

Name: MS. ADEBAYO ADEBOLA
Title or Position: ADMINISTRATOR
Credential:
Phone: 281-298-4014