Provider Demographics
NPI:1083436653
Name:MUYAH, FANESSE AWOM
Entity type:Individual
Prefix:
First Name:FANESSE
Middle Name:AWOM
Last Name:MUYAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12370 NEWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-3910
Mailing Address - Country:US
Mailing Address - Phone:346-235-4136
Mailing Address - Fax:
Practice Address - Street 1:3100 CLEBURNE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4501
Practice Address - Country:US
Practice Address - Phone:713-313-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program