Healthcare Provider Details

I. General information

NPI: 1033984752
Provider Name (Legal Business Name): HEAVEN ORONA CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N WASHINGTON AVE
DALLAS TX
75246-1754
US

IV. Provider business mailing address

10619 BENBROOK DR
DALLAS TX
75228-2733
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-8202
  • Fax:
Mailing address:
  • Phone: 214-536-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number289158
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: