Healthcare Provider Details

I. General information

NPI: 1871317834
Provider Name (Legal Business Name): RADI.8 MEDICAL SPA & PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 W FIRST ST BUILDING C SUITE 20
PROSPER TX
75078
US

IV. Provider business mailing address

2760 W FIRST ST BUILDING C SUITE 20
PROSPER TX
75078
US

V. Phone/Fax

Practice location:
  • Phone: 469-803-0849
  • Fax:
Mailing address:
  • Phone: 469-803-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: YUAN ZHAO
Title or Position: OWNER
Credential: FNP-C
Phone: 469-803-0849