MEDICARE: JOSELLA INVESTMENT LLC

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1902412125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSELLA INVESTMENT LLC

Provider Business Mailing Address
First Line	:	3831 TARRAGON BEND DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-2618
Country	:	US
Telephone Number	:	713-478-2758
Fax Number	:

Provider Business Practice Location Address
First Line	:	3831 TARRAGON BEND DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-2618
Country	:	US
Telephone Number	:	713-478-2758
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. ADESOLA W OLUTAYO
Credential	:
Telephone Number	:	713-478-2758

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	09/22/2020

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