Provider Information for 1376962290
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ROMESHA JACKSON
Sex: Female
NPI: 1376962290
Last Updated: 2024-07-29
Certification Date: 2024-07-29
Certification Date: 2024-07-29
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1376962290 | ||||||||
| Enumeration Date | 2014-04-08 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 715 MARNE LN HOUSTON, TX 77090-1927 United States Phone: 209-242-3676 | Fax: | ||||||||
| Primary Practice Address | 701 N POST OAK RD STE 145 HOUSTON, TX 77024-3923 United States Phone: 713-364-6275 | Fax: | ||||||||
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