Healthcare Provider Details

I. General information

NPI: 1003403122
Provider Name (Legal Business Name): RENE RESENDIZ FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 REAGAN ST
DALLAS TX
75219-3403
US

IV. Provider business mailing address

2701 REAGAN ST
DALLAS TX
75219-3403
US

V. Phone/Fax

Practice location:
  • Phone: 214-540-4492
  • Fax: 214-615-1387
Mailing address:
  • Phone: 214-540-4492
  • Fax: 214-615-1387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1021079
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: