Provider Demographics
NPI:1922754779
Name:JUST DIVINE MEDICLINIC & MEDISPA ,LLC
Entity Type:Organization
Organization Name:JUST DIVINE MEDICLINIC & MEDISPA ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:TONDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:832-319-0696
Mailing Address - Street 1:PO BOX 60023
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77205-0023
Mailing Address - Country:US
Mailing Address - Phone:832-319-0696
Mailing Address - Fax:659-234-3758
Practice Address - Street 1:21650 ALDINE WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-1092
Practice Address - Country:US
Practice Address - Phone:832-319-0696
Practice Address - Fax:659-234-3758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty