Individual
LICIAMMA JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4600 E SAM HOUSTON PKWY S, PASADENA, TX 77505-3948
(713) 948-7388
Mailing address
2708 RAVEN RIDGE DR, PEARLAND, TX 77584-3442
(713) 436-1818
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP138632
TX
Other
Enumeration date
04/13/2019
Last updated
04/13/2019
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