Provider Demographics
NPI:1619747961
Name:CUSTOMIZED WELLNESS LLC
Entity Type:Organization
Organization Name:CUSTOMIZED WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKWUNYERE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-785-3347
Mailing Address - Street 1:54 HOPE FARM RD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2480
Mailing Address - Country:US
Mailing Address - Phone:832-785-3347
Mailing Address - Fax:
Practice Address - Street 1:8421 FM 521
Practice Address - Street 2:SUITE D
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583
Practice Address - Country:US
Practice Address - Phone:346-582-3945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty