=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467910570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEAXON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2019
-----------------------------------------------------
Last Update Date | 08/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5231 SHADOW BREEZE LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-4870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-515-7058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23501 CINCO RANCH BLVD STE H120 PMB 265
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-3109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-825-7899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | FELIX M ZEQUEIRA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-515-7058
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------