Healthcare Provider Details

I. General information

NPI: 1891233920
Provider Name (Legal Business Name): CARLA RESENDIZ HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 09/03/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N'OCONNONR STE. 102B
IRVING TX
75062-4148
US

IV. Provider business mailing address

750 N COMMONS DR STE 200
AURORA IL
60504-7940
US

V. Phone/Fax

Practice location:
  • Phone: 972-252-9360
  • Fax: 972-252-7516
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number80725
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: