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Organization
JACKSON SURGICAL CONSULTANTS P.A.
Active
Organization
JACKSON SURGICAL CONSULTANTS P.A.
Active
Other names
Revive Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MARISSA DELUNA (CREDENTIALING MANAGER)
(713) 800-3359
Entity
Organization
Contact information
Practice address
1110 S FRIENDSWOOD DR, FRIENDSWOOD, TX 77546-5698
(409) 299-4785
(409) 220-8348
Mailing address
12337 JONES RD STE 427, HOUSTON, TX 77070-4951
(409) 299-4785
(409) 220-8348
Taxonomy
Speciality
Code
Description
License number
State
171400000X
Health & Wellness Coach
—
NULL
171400000X
Health & Wellness Coach
—
—
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
01/18/2022
Last updated
02/03/2022
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