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General NPI Number Information
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NPI Number | 1063772861
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Entity Type | Organization
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Legal Business Name | CITYDOC URGENT CARE CENTER 4, PLLC
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Dates
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Enumeration Date | 05/25/2012
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 2791 MATLOCK RD SUITE B
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City | MANSFIELD
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State | TX
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Zip | 76063
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Country | US
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Telephone | 214-871-7000
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Fax | 214-871-7020
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Provider Business Mailing Address
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Address Line | 2807 ALLEN ST PMB 358
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City | DALLAS
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State | TX
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Zip | 75204-1031
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Country | US
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Telephone | 214-871-7000
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Fax | 214-871-7020
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Authorized Official
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Title or Position | CREDENTIALING
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Name | ANGIE VASQUEZ
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Credential |
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Telephone | 214-871-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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