Provider Demographics
NPI:1962979864
Name:JARRA, ELOISA
Entity type:Individual
Prefix:
First Name:ELOISA
Middle Name:
Last Name:JARRA
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 1:4953 E RIDGE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-4638
Mailing Address - Country:US
Mailing Address - Phone:832-578-8339
Mailing Address - Fax:
Practice Address - Street 1:4953 E RIDGE CREEK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-4638
Practice Address - Country:US
Practice Address - Phone:832-578-8339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities