| NPI | 1396100798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLIVIA HERNANDEZ Credentialing Specialist 972-364-8253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA 43478) |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2015-12-30 |