Provider Demographics
NPI:1790161149
Name:BUSOGI, JANVIER
Entity Type:Individual
Prefix:MR
First Name:JANVIER
Middle Name:
Last Name:BUSOGI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15006 PREACHERS LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2254
Mailing Address - Country:US
Mailing Address - Phone:469-685-5124
Mailing Address - Fax:
Practice Address - Street 1:15006 PREACHERS LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-2254
Practice Address - Country:US
Practice Address - Phone:469-685-5124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58-2491253146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
58-2491253OtherFEDERAL TAX ID