Healthcare Provider Details

I. General information

NPI: 1417714197
Provider Name (Legal Business Name): PREMIUM HEALTH HOUSE CALLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 09/11/2025
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20302 OAKMOSS CT
SPRING TX
77379-2569
US

IV. Provider business mailing address

20302 OAKMOSS CT
SPRING TX
77379-2569
US

V. Phone/Fax

Practice location:
  • Phone: 713-909-6864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEYVIS CAMEJO BUSTO
Title or Position: MANAGER
Credential: FNP-BC
Phone: 713-909-6864