| NPI | 1508193251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANN DOMINGUEZ Insurance Coordinator 214-369-6411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX D3468) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2013-10-29 |