Healthcare Provider Details

I. General information

NPI: 1467863688
Provider Name (Legal Business Name): PROMEDICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 CHESAPEAKE DR
GARLAND TX
75043-0901
US

IV. Provider business mailing address

2605 CHESAPEAKE DR
GARLAND TX
75043-0901
US

V. Phone/Fax

Practice location:
  • Phone: 214-714-0117
  • Fax: 469-298-3335
Mailing address:
  • Phone: 214-714-0117
  • Fax: 469-298-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number513568
License Number StateTX

VIII. Authorized Official

Name: TIMONET ABULOC
Title or Position: PRESIDENT
Credential: NP
Phone: 214-714-0117