Organization
MEDFAST PEDIATRIC & FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUBUNMI OLUFUNKE KAZZIM FNP- C (DIRECTOR)
(832) 847-1527
Entity
Organization
Contact information
Practice address
14520 OLD KATY RD, ST 109, HOUSTON, TX 77079
(832) 847-1527
Mailing address
14520 OLD KATY RD, ST 109, HOUSTON, TX 77079
(832) 847-1527
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP128920
TX
363LF0000X
Family Nurse Practitioner
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Other
Enumeration date
09/28/2015
Last updated
09/29/2015
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