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General NPI Number Information
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NPI Number | 1417484114
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Entity Type | Organization
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Legal Business Name | KIDZ-R-US
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Dates
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Enumeration Date | 05/12/2017
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Last Update Date | 05/12/2017
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Provider Practice Location Address
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Address Line | 12808 VETERANS MEMORIAL DR
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City | HOUSTON
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State | TX
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Zip | 77014-2004
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Country | US
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Telephone | 936-499-3720
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Fax | 888-664-6404
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Provider Business Mailing Address
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Address Line | PO BOX 79855
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City | HOUSTON
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State | TX
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Zip | 77279-9855
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Country | US
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Telephone | 936-499-3720
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Fax | 888-664-6404
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Authorized Official
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Title or Position | DIRECTOR
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Name | LONNIE DEGGINS
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Credential |
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Telephone | 936-499-3720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 08693
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 568702
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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