MEDICARE: JACQUELINE TEZENO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1235783911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE TEZENO

Provider Business Mailing Address
First Line	:	11575 PEARLAND PKWY APT 10202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-2661
Country	:	US
Telephone Number	:	281-989-3701
Fax Number	:

Provider Business Practice Location Address
First Line	:	11575 PEARLAND PKWY APT 10202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-2661
Country	:	US
Telephone Number	:	281-989-3701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	07/30/2019

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Directions to “ JACQUELINE TEZENO ” Practice Location

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