Provider Demographics
NPI:1821578071
Name:TIENTCHEU MAMVOU, JOCELYNE NOELLA
Entity Type:Individual
Prefix:
First Name:JOCELYNE NOELLA
Middle Name:
Last Name:TIENTCHEU MAMVOU
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 1:1255 N POST OAK RD APT 4305
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7340
Mailing Address - Country:US
Mailing Address - Phone:949-302-2145
Mailing Address - Fax:
Practice Address - Street 1:2800 NORTH LOOP W # 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-8838
Practice Address - Country:US
Practice Address - Phone:713-936-6249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63201183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist