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General NPI Number Information
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NPI Number | 1508801119
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Entity Type | Organization
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Legal Business Name | PREVENTIVE HEALTH & WELLNESS GROUP, INC.
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14219 BRENTSHIRE LN
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City | HOUSTON
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State | TX
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Zip | 77069-1441
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Country | US
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Telephone | 832-249-6200
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Fax | 832-249-9205
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Provider Business Mailing Address
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Address Line | 14219 BRENTSHIRE LN
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City | HOUSTON
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State | TX
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Zip | 77069-1441
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Country | US
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Telephone | 800-742-2368
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Fax | 937-291-2962
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DEVITA J DAVIS
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Credential |
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Telephone | 281-444-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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