Provider Demographics
NPI:1699381103
Name:XENOS, ISABELLE CAMBOULIVES (LMT)
Entity Type:Individual
Prefix:
First Name:ISABELLE
Middle Name:CAMBOULIVES
Last Name:XENOS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-8078
Mailing Address - Country:US
Mailing Address - Phone:714-856-5150
Mailing Address - Fax:
Practice Address - Street 1:265 HEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:DRIFTWOOD
Practice Address - State:TX
Practice Address - Zip Code:78619-8078
Practice Address - Country:US
Practice Address - Phone:714-856-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT114405225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT114405OtherTEXAS DEPARTMENT LICENSING REGULATION TDLR