Healthcare Provider Details

I. General information

NPI: 1063060564
Provider Name (Legal Business Name): RACHEL MARISCAL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 N CENTRAL EXPY STE 420
DALLAS TX
75231-5945
US

IV. Provider business mailing address

9101 N CENTRAL EXPY STE 420
DALLAS TX
75231-5945
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-8220
  • Fax:
Mailing address:
  • Phone: 214-820-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142609
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: