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General NPI Number Information
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NPI Number | 1275172827
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Entity Type | Individual
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Provider Name | TINA MONE PATTERSON COSMETOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 8501 OLD HICKORY TRL APT 2106
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City | DALLAS
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State | TX
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Zip | 75237-3821
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Country | US
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Telephone | 254-531-1057
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Fax |
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Provider Business Mailing Address
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Address Line | 823 SAN JUAN DR
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City | DUNCANVILLE
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State | TX
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Zip | 75116-3921
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Country | US
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Telephone | 254-531-1057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1792338
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License Number State | TX
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