Individual
LAETITIA FOMBON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1512 E GRIFFIN PKWY STE 5, MISSION, TX 78572-2422
(956) 600-8991
Mailing address
1512 E GRIFFIN PKWY STE 5, MISSION, TX 78572-2422
(956) 600-8991
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
312120
TX
261QA0600X
Adult Day Care Clinic/Center
312120
TX
Other
Enumeration date
06/03/2025
Last updated
06/04/2025
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