Individual
RENJU SEBASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4000
(713) 792-6161
Mailing address
PO BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
AP132793
TX
363LG0600X
Gerontology Nurse Practitioner
Primary
AP132793
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
396782002
—
TX
01
—
396782003
MEDICAID- CSHCN
TX
Enumeration date
07/23/2018
Last updated
03/12/2020
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