Provider Demographics
NPI:1972832053
Name:KCJZ LLC
Entity type:Organization
Organization Name:KCJZ LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:IVONNE
Authorized Official - Last Name:CERVANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-379-2900
Mailing Address - Street 1:8443 AIRLINE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77037-3213
Mailing Address - Country:US
Mailing Address - Phone:832-379-2900
Mailing Address - Fax:832-379-2920
Practice Address - Street 1:8443 AIRLINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-3213
Practice Address - Country:US
Practice Address - Phone:832-379-2900
Practice Address - Fax:832-379-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care