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General NPI Number Information
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NPI Number | 1295526325
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Entity Type | Individual
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Provider Name | FRANCK IVAN MOUGWA DIMO
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Gender | Male
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 4429 EVESLAGE LN
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City | CONROE
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State | TX
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Zip | 77304-2464
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Country | US
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Telephone | 936-283-1628
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Fax |
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Provider Business Mailing Address
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Address Line | 4429 EVESLAGE LN
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City | CONROE
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State | TX
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Zip | 77304-2464
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Country | US
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Telephone | 936-444-7279
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Fax | 936-444-7279
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 41166863
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number | 41166863
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License Number State | TX
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