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General NPI Number Information
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NPI Number | 1396511820
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Entity Type | Organization
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Legal Business Name | MADDOX INVT LLC
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 7555 BELLAIRE BLVD STE C
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City | HOUSTON
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State | TX
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Zip | 77036-5055
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Country | US
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Telephone | 832-466-5534
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Fax |
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Provider Business Mailing Address
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Address Line | 24603 DOVER BEND WAY
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City | RICHMOND
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State | TX
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Zip | 77406-2841
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Country | US
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Telephone | 832-466-5534
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | FABIOLA YASIRA BOTLER IZAGUIRRE
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Credential |
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Telephone | 832-466-5534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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