Provider Demographics
NPI:1578986154
Name:JASON, TRISTA
Entity Type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:JASON
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:STE. 801
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1337
Mailing Address - Country:US
Mailing Address - Phone:281-919-1024
Mailing Address - Fax:281-919-1790
Practice Address - Street 1:14405 WALTERS RD
Practice Address - Street 2:STE. 801
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1337
Practice Address - Country:US
Practice Address - Phone:281-919-1024
Practice Address - Fax:281-919-1790
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-01
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251E00000XAgenciesHome Health