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General NPI Number Information
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NPI Number | 1184053902
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Entity Type | Organization
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Legal Business Name | BRILLIANTLY BABY
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 10190 KATY FWY STE 450
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City | HOUSTON
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State | TX
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Zip | 77043-5297
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Country | US
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Telephone | 832-224-6304
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Fax |
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Provider Business Mailing Address
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Address Line | 10190 KATY FWY STE 450
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City | HOUSTON
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State | TX
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Zip | 77043-5297
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Country | US
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Telephone | 832-224-6304
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | MS. DECHELLE P PIERSON
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Credential | RN, BSN
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Telephone | 832-224-6304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 1001183
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License Number State | TX
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