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General NPI Number Information
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NPI Number | 1710738034
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Entity Type | Organization
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Legal Business Name | ENROUTE PROVIDERS LLC
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Dates
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Enumeration Date | 03/27/2024
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 5625 CYPRESS CREEK PKWY STE 408
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City | HOUSTON
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State | TX
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Zip | 77069-4211
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Country | US
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Telephone | 832-762-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 5625 CYPRESS CREEK PKWY STE 408
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City | HOUSTON
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State | TX
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Zip | 77069-4211
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Country | US
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Telephone | 832-762-4722
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Fax | 888-781-5104
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Authorized Official
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Title or Position | FOUNDER
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Name | RYAN NOEL LARROZA
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Credential | MSN, RN
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Telephone | 832-762-4721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 163WW0000X
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Taxonomy Name | Wound Care 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 | 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 #4
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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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