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General NPI Number Information
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NPI Number | 1396048708
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Entity Type | Individual
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Provider Name | JUANITA LASHET BATES
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Gender | Female
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 07/24/2020
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Provider Practice Location Address
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Address Line | 7022 LIMESTONE CIR
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City | MANVEL
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State | TX
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Zip | 77578-5274
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Country | US
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Telephone | 832-665-5111
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Fax | 832-336-4746
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Provider Business Mailing Address
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Address Line | 7022 LIMESTONE CIR
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City | MANVEL
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State | TX
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Zip | 77578-5274
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Country | US
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Telephone | 832-665-5111
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Fax | 832-336-4746
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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 | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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