Provider Demographics
NPI:1558736009
Name:MBAMEG MAHENDJE, BRICE
Entity Type:Individual
Prefix:
First Name:BRICE
Middle Name:
Last Name:MBAMEG MAHENDJE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHANTAL
Other - Middle Name:MARTHE
Other - Last Name:MAHENDJE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5258 SAN PABLO GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-4043
Mailing Address - Country:US
Mailing Address - Phone:832-507-8769
Mailing Address - Fax:
Practice Address - Street 1:5258 SAN PABLO GARDENS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-4043
Practice Address - Country:US
Practice Address - Phone:832-507-8769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMEDICAL TRANSPORTMedicaid