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General NPI Number Information
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NPI Number | 1407507809
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Entity Type | Organization
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Legal Business Name | ELITE GYNECOLOGY AND MED SPA
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Dates
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Enumeration Date | 01/17/2022
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 255 W LEBANON STE 208
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City | FRISCO
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State | TX
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Zip | 75036-3404
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Country | US
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Telephone | 430-201-5004
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Fax |
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Provider Business Mailing Address
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Address Line | 2113 HARWOOD RD STE 309
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City | BEDFORD
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State | TX
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Zip | 76021-4703
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Country | US
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Telephone | 386-506-9528
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JESSICA PEARCE
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Credential | D.O
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Telephone | 386-506-9528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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