Provider Demographics
NPI:1184479966
Name:AMENU, LAMESA C
Entity type:Individual
Prefix:
First Name:LAMESA
Middle Name:C
Last Name:AMENU
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 1:5402 RENWICK DR APT 1008
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1531
Mailing Address - Country:US
Mailing Address - Phone:860-381-9902
Mailing Address - Fax:
Practice Address - Street 1:5402 RENWICK DR APT 1008
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1531
Practice Address - Country:US
Practice Address - Phone:860-381-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology