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General NPI Number Information
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NPI Number | 1699573733
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Entity Type | Organization
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Legal Business Name | XPLOSION TECHNOLOGY CORPORATION
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 1803 AMBASSADOR CT
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City | MISSOURI CITY
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State | TX
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Zip | 77459-3758
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Country | US
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Telephone | 832-969-3686
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Fax |
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Provider Business Mailing Address
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Address Line | 1803 AMBASSADOR CT
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City | MISSOURI CITY
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State | TX
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Zip | 77459-3758
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Country | US
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Telephone | 832-969-3686
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Fax |
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Authorized Official
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Title or Position | COO
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Name | ISIS ASHFORD
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Credential |
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Telephone | 832-969-3686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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