Individual
CLARISSE MASENGO MUTOMBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
150 KLATTENHOFF LN, 3204, HUTTO, TX 78634-4601
(917) 355-3458
Mailing address
150 KLATTENHOFF LN, 3204, HUTTO, TX 78634-4601
(917) 355-3458
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
372500000X
Chore Provider
—
—
372600000X
Adult Companion
—
—
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
—
—
374K00000X
Religious Nonmedical Practitioner
—
—
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
09/15/2011
Last updated
09/15/2011
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