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General NPI Number Information
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NPI Number | 1255726758
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Entity Type | Organization
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Legal Business Name | VISION PARK CLINICAL GROUP, LLC
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Dates
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Enumeration Date | 04/01/2015
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Last Update Date | 04/01/2015
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Provider Practice Location Address
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Address Line | 119 VISION PARK BLVD
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City | SHENANDOAH
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State | TX
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Zip | 77384-3001
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Country | US
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Telephone | 281-900-7590
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Fax |
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Provider Business Mailing Address
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Address Line | 119 VISION PARK BLVD
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City | SHENANDOAH
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State | TX
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Zip | 77384-3001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SABRINA LAHIRI
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Credential |
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Telephone | 281-900-9750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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