Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TH0100X | Health Service |
NPI | 1295266989 |
---|---|
Provider Name | Ange L Kayumba |
First Address | Houston, TX 77081-1103 |
Second Address | Houston, TX 77082-2421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2017 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3746224 | (05) | TX |