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General NPI Number Information
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NPI Number | 1396068805
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Entity Type | Organization
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Legal Business Name | WHITE ROCK CLINIC LLC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 03/11/2010
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Provider Practice Location Address
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Address Line | 9102 GARLAND RD
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City | DALLAS
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State | TX
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Zip | 75218-3901
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Country | US
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Telephone | 214-327-2883
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Fax | 214-327-2471
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Provider Business Mailing Address
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Address Line | 9102 GARLAND RD
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City | DALLAS
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State | TX
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Zip | 75218-3901
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Country | US
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Telephone | 214-327-2883
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Fax | 214-327-2471
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAUL A LOZANO
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Credential | PA-C
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Telephone | 214-327-2883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | K9223
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License Number State | TX
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