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General NPI Number Information
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NPI Number | 1174277412
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Entity Type | Organization
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Legal Business Name | BLUEBONNET OSR ASSOCIATES
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 7750 N. MACARTHUR BLVD. SUITE 120
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City | IRVING
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State | TX
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Zip | 75063
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Country | US
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Telephone | 216-825-5879
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Fax |
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Provider Business Mailing Address
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Address Line | 450 S DENTON TAP RD UNIT 442
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City | COPPELL
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State | TX
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Zip | 75019-7117
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Country | US
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Telephone | 216-825-5879
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Fax |
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | MANSI LALWANI
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Credential |
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Telephone | 216-825-5879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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