Healthcare Provider Details

I. General information

NPI: 1609496413
Provider Name (Legal Business Name): DR. JESWINA JOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 UPTOWN BLVD STE 120
CEDAR HILL TX
75104-3537
US

IV. Provider business mailing address

12377 MERIT DR STE 300
DALLAS TX
75251-3126
US

V. Phone/Fax

Practice location:
  • Phone: 972-293-6300
  • Fax:
Mailing address:
  • Phone: 972-957-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberU2886
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: