Provider Demographics
NPI:1396511820
Name:MADDOX INVT LLC
Entity type:Organization
Organization Name:MADDOX INVT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FABIOLA
Authorized Official - Middle Name:YASIRA
Authorized Official - Last Name:BOTLER IZAGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-466-5534
Mailing Address - Street 1:24603 DOVER BEND WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2841
Mailing Address - Country:US
Mailing Address - Phone:832-466-5534
Mailing Address - Fax:
Practice Address - Street 1:7555 BELLAIRE BLVD STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-5055
Practice Address - Country:US
Practice Address - Phone:832-466-5534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA