1760682017 NPI number — MIXED BLESSINGS, LLC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760682017 NPI number — MIXED BLESSINGS, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIXED BLESSINGS, LLC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760682017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7811 BLAZING GAP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSOURI CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77459-6037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-778-9587
Provider Business Mailing Address Fax Number:
281-778-9587

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7811 BLAZING GAP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOURI CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77459-6037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-778-9587
Provider Business Practice Location Address Fax Number:
281-778-9587
Provider Enumeration Date:
07/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ILANGA
Authorized Official First Name:
MARIO
Authorized Official Middle Name:
BALIAO
Authorized Official Title or Position:
PRESIDENT/CFO
Authorized Official Telephone Number:
281-778-9587

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  UNDER PROCESS , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)