Individual
JALISA LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3333 SOUTHFORK PKWY APT 114, MANVEL, TX 77578-3766
(832) 660-4936
Mailing address
3333 SOUTHFORK PKWY APT 114, MANVEL, TX 77578-3766
(832) 660-4936
Taxonomy
Speciality
Code
Description
License number
State
347E00000X
Transportation Broker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
TX
Enumeration date
01/30/2023
Last updated
01/31/2023
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