Healthcare Provider Details

I. General information

NPI: 1689075095
Provider Name (Legal Business Name): P37 IOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 LITTLE CUB WAY
EULESS TX
76039-6086
US

IV. Provider business mailing address

803 LITTLE CUB WAY
EULESS TX
76039-6086
US

V. Phone/Fax

Practice location:
  • Phone: 682-560-9127
  • Fax: 817-494-3249
Mailing address:
  • Phone: 682-560-9127
  • Fax: 817-494-3249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberF0555
License Number StateTX

VIII. Authorized Official

Name: DAVE MENDEZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 682-560-9127