Healthcare Provider Details

I. General information

NPI: 1386247773
Provider Name (Legal Business Name): JIMERE JONTELLE SAYON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 CRESTWAY RD STE 200B
WINDCREST TX
78239-1975
US

IV. Provider business mailing address

8332 CHASEMONT CT
CONVERSE TX
78109-3860
US

V. Phone/Fax

Practice location:
  • Phone: 210-310-3864
  • Fax:
Mailing address:
  • Phone: 210-371-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number308648
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: