MEDICARE: MR. RAUL OZUNA JR. LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	114023	TX

General Provider Information

NPI Number	:	1356160311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAUL OZUNA JR. LMSW

Provider Business Mailing Address
First Line	:	4732 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-6502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4732 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-6502
Country	:	US
Telephone Number	:	214-540-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

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