Healthcare Provider Details

I. General information

NPI: 1457313462
Provider Name (Legal Business Name): MIGUEL NARVAEZ MOJICA CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD
DALLAS TX
75390-7208
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-0624
  • Fax: 214-645-0078
Mailing address:
  • Phone: 214-645-0624
  • Fax: 214-645-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number76
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: