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General NPI Number Information
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NPI Number | 1366263881
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Entity Type | Organization
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Legal Business Name | PHYSICIANS CHOICE LYMPHEDEMA OUT PATIENT CLINIC INC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 3306 RIVERWAY CT
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City | MESQUITE
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State | TX
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Zip | 75181-4298
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Country | US
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Telephone | 972-489-8231
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Fax |
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Provider Business Mailing Address
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Address Line | 3306 RIVERWAY CT
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City | MESQUITE
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State | TX
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Zip | 75181-4298
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Country | US
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Telephone | 972-489-8231
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAGDALENE OBAROGHEDO
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Credential |
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Telephone | 972-489-8231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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