Provider Demographics
NPI:1346539590
Name:MOMBY LLC
Entity type:Organization
Organization Name:MOMBY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-480-6820
Mailing Address - Street 1:2715 BISSONNET ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1340
Mailing Address - Country:US
Mailing Address - Phone:713-942-2051
Mailing Address - Fax:713-942-2032
Practice Address - Street 1:2715 BISSONNET ST
Practice Address - Street 2:SUITE 507
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-1340
Practice Address - Country:US
Practice Address - Phone:713-942-2051
Practice Address - Fax:713-942-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty