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General NPI Number Information
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NPI Number | 1922754779
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Entity Type | Organization
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Legal Business Name | JUST DIVINE MEDICLINIC & MEDISPA ,LLC
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 21650 ALDINE WESTFIELD RD
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City | HUMBLE
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State | TX
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Zip | 77338-1092
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Country | US
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Telephone | 832-319-0696
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Fax | 659-234-3758
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Provider Business Mailing Address
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Address Line | PO BOX 60023
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City | HOUSTON
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State | TX
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Zip | 77205-0023
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Country | US
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Telephone | 832-319-0696
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Fax | 659-234-3758
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Authorized Official
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Title or Position | COO
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Name | TONDRA ROBINSON
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Credential | NP
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Telephone | 832-319-0696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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