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General NPI Number Information
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NPI Number | 1366635708
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Entity Type | Organization
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Legal Business Name | WOMEN'S WELLNESS CENTER AT WHITE ROCK
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Dates
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Enumeration Date | 08/20/2007
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 1151 N BUCKNER BLVD #301A
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City | DALLAS
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State | TX
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Zip | 75218-3426
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Country | US
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Telephone | 214-324-2401
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Fax | 214-321-5052
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Provider Business Mailing Address
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Address Line | 1151 N BUCKNER BLVD #301A
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City | DALLAS
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State | TX
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Zip | 75218-3426
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Country | US
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Telephone | 214-324-2401
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Fax | 214-321-5052
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LATASHA JARRETT
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Credential |
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Telephone | 214-324-2401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | M1163
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License Number State | TX
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