MEDICARE: JESWIN JAISON VENNATT

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1831032044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESWIN JAISON VENNATT

Provider Business Mailing Address
First Line	:	1 BAYLOR PLZ
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3411
Country	:	US
Telephone Number	:	713-798-4870
Fax Number	:	713-798-1479

Provider Business Practice Location Address
First Line	:	1977 BUTLER BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4101
Country	:	US
Telephone Number	:	713-798-4870
Fax Number	:	713-798-1479

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/14/2026

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