| NPI | 1053042796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEENI LUZ DE LA ROSA PEREZ Medical Director 817-513-5155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QH0100X Clinic/Center Health Service | |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2023-02-17 |