Healthcare Provider Details

I. General information

NPI: 1427228089
Provider Name (Legal Business Name): BARBARA DALASTA RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 HARRIS PKWY
FORT WORTH TX
76132-4101
US

IV. Provider business mailing address

PO BOX 2626
FORT WORTH TX
76113-2626
US

V. Phone/Fax

Practice location:
  • Phone: 817-346-6565
  • Fax:
Mailing address:
  • Phone: 817-294-7444
  • Fax: 817-294-7172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number536808
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: