Healthcare Provider Details

I. General information

NPI: 1942499470
Provider Name (Legal Business Name): MARIA DEL CARMEN FUNES LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 RANDOL MILL ROAD
ARLINGTON TX
76012
US

IV. Provider business mailing address

2301 WILMETTE DR
ARLINGTON TX
76018-2582
US

V. Phone/Fax

Practice location:
  • Phone: 817-804-4400
  • Fax:
Mailing address:
  • Phone: 714-856-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number205934
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: