Healthcare Provider Details

I. General information

NPI: 1295669513
Provider Name (Legal Business Name): CLINICAL SPECIALTY INFUSIONS OF DALLAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CORPORATE CIR STE G-I
GOLDEN CO
80401-5642
US

IV. Provider business mailing address

5340 LEGACY DR STE 115
PLANO TX
75024-3393
US

V. Phone/Fax

Practice location:
  • Phone: 833-569-1005
  • Fax: 430-200-4889
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MARITZA MORA
Title or Position: DIRECTOR OF LEGAL AND COMPLIANCE
Credential:
Phone: 430-213-1563