Individual
EZEKIEL KAMONJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
914 BENS DR, ANNA, TX 75409-5102
(314) 269-3760
Mailing address
914 BENS DR, ANNA, TX 75409-5102
(314) 269-3760
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
352345
TX
Other
Enumeration date
02/17/2020
Last updated
02/17/2020
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