Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP132589 | TX |
NPI | 1043748759 |
---|---|
Provider Name | Jiji Balu Zachariah |
First Address | Missouri City, TX 77459-7069 |
Second Address | Houston, TX 77027-7313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2017 |
Last Update Date | 24/05/2017 |