Individual
LILLYKUTTY J JACOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6411 FANNIN ST, HOUSTON, TX 77030-1501
(713) 704-2150
Mailing address
6815 RHODES CT, MISSOURI CITY, TX 77459-5040
(713) 505-3930
Taxonomy
Speciality
Code
Description
License number
State
163WX0800X
Orthopedic Registered Nurse
Primary
753583
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
913623317
MEMORIAL HEALTH SYSTEMS
TX
Enumeration date
02/06/2019
Last updated
02/06/2019
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