MEDICARE: ANOTHER VICTORIOUS INDIVIDUAL PROSPERING

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1841748092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANOTHER VICTORIOUS INDIVIDUAL PROSPERING

Provider Business Mailing Address
First Line	:	918 GARDEN LAND CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-5540
Country	:	US
Telephone Number	:	832-282-3493
Fax Number	:	281-982-3768

Provider Business Practice Location Address
First Line	:	918 GARDEN LAND CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77073-5540
Country	:	US
Telephone Number	:	832-282-3493
Fax Number	:	281-982-3768

Authorized Official
Title or Position	:	OWNER/SUPERVISOR
Name	:	CYNTHIA D JONES
Credential	:
Telephone Number	:	832-282-3493

Provider Enumeration Date	:	09/16/2016
Last Update Date	:	09/16/2016

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Directions to “ANOTHER VICTORIOUS INDIVIDUAL PROSPERING ” Practice Location

Language	Start Address	Practice Location

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