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General NPI Number Information
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NPI Number | 1407334980
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Entity Type | Individual
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Provider Name | EDGAR CARMONA
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Gender | Male
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 09/02/2023
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Provider Practice Location Address
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Address Line | 2426 W KIEST BLVD
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City | DALLAS
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State | TX
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Zip | 75233-2306
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Country | US
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Telephone | 972-878-5968
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 210151
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City | DALLAS
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State | TX
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Zip | 75211-0151
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Country | US
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Telephone | 972-788-5968
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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 | 332S00000X
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Taxonomy Name | Hearing Aid Equipment
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License Number | 80571
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License Number State | TX
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