Healthcare Provider Details

I. General information

NPI: 1750170809
Provider Name (Legal Business Name): DYNAMIC COMPREHENSIVE SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14090 SOUTHWEST FWY STE 300
SUGAR LAND TX
77478-3679
US

IV. Provider business mailing address

14090 SOUTHWEST FWY STE 300
SUGAR LAND TX
77478-3679
US

V. Phone/Fax

Practice location:
  • Phone: 832-334-8427
  • Fax: 281-805-1386
Mailing address:
  • Phone: 832-334-8427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TANISHA MANGON
Title or Position: OWNER
Credential:
Phone: 832-334-8427