Healthcare Provider Details

I. General information

NPI: 1578049052
Provider Name (Legal Business Name): CONCEPTIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 WARREN PKWY STE 201
FRISCO TX
75034-4199
US

IV. Provider business mailing address

8380 WARREN PKWY STE 201
FRISCO TX
75034-4199
US

V. Phone/Fax

Practice location:
  • Phone: 972-377-2625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State

VIII. Authorized Official

Name: DORETTE NOORHASAN
Title or Position: MANAGER
Credential:
Phone: 972-377-2625