Organization
TAMYRA COMEAUX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RHONDA DALLAS (PRACTICE ADMINISTRATOR)
(832) 237-4269
Entity
Organization
Contact information
Practice address
11811 FM 1960 RD W, HOUSTON, TX 77065-3827
(832) 237-4269
Mailing address
11811 FM 1960 RD W, HOUSTON, TX 77065-3827
(832) 237-4269
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
L0096
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030224201
—
TX
Enumeration date
11/26/2014
Last updated
11/26/2014
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