Provider Demographics
NPI:1174161848
Name:JATTO, TOMMY SUNDAY
Entity type:Individual
Prefix:MR
First Name:TOMMY
Middle Name:SUNDAY
Last Name:JATTO
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 1:6207 GRANDVALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77072-1517
Mailing Address - Country:US
Mailing Address - Phone:848-482-6852
Mailing Address - Fax:
Practice Address - Street 1:6239 PRESIDIO CANYON DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8757
Practice Address - Country:US
Practice Address - Phone:848-482-6852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02071926347E00000X
342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX02071926Medicaid