NPI age
19 years
Enumerated 2007-04-18
Across 290 active public health or welfare providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | PH0717 | MEDICARE PTAN |
| 05 (TX) | 130736503 | |
| 05 (TX) | 1356567325 | |
| 05 (TX) | 130736505 |
Doing-business-as, former, and alternate names recorded by NPPES.
Single-site organization. Only one practice location on file.
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