Healthcare Provider Details

I. General information

NPI: 1902663842
Provider Name (Legal Business Name): NATALIE MARIE VATINYAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 WALNUT HILL LN STE 710
DALLAS TX
75231-4427
US

IV. Provider business mailing address

8267 ELMBROOK DR STE 200
DALLAS TX
75247-4078
US

V. Phone/Fax

Practice location:
  • Phone: 214-368-6707
  • Fax:
Mailing address:
  • Phone: 214-424-2200
  • Fax: 214-231-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18059
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: