Healthcare Provider Details

I. General information

NPI: 1154967453
Provider Name (Legal Business Name): SOMERSET MOM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 WALNUT HILL LN
DALLAS TX
75231-4426
US

IV. Provider business mailing address

745 OAKLAND HILLS CIR APT 111
LAKE MARY FL
32746-5847
US

V. Phone/Fax

Practice location:
  • Phone: 214-863-6000
  • Fax:
Mailing address:
  • Phone: 407-302-0089
  • Fax: 407-807-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA G REMEDIOS
Title or Position: OWNER
Credential: MD
Phone: 407-302-0089