Provider Demographics
NPI:1699977645
Name:WILLIS, ROSHONDA
Entity type:Individual
Prefix:
First Name:ROSHONDA
Middle Name:
Last Name:WILLIS
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 1:14405 WALTERS RD
Mailing Address - Street 2:SUITE 825
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1337
Mailing Address - Country:US
Mailing Address - Phone:832-484-8948
Mailing Address - Fax:832-484-8949
Practice Address - Street 1:14405 WALTERS RD
Practice Address - Street 2:SUITE 825
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1337
Practice Address - Country:US
Practice Address - Phone:832-484-8948
Practice Address - Fax:832-484-8949
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor