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General NPI Number Information
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NPI Number | 1407596794
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Entity Type | Organization
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Legal Business Name | STAR TREATMENT HEALTHCARE SERVICES AND MED SPA
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 7125 MARVIN D LOVE FWY STE 207
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City | DALLAS
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State | TX
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Zip | 75237-3155
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Country | US
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Telephone | 469-709-8237
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Fax | 214-387-1161
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Provider Business Mailing Address
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Address Line | 7125 MARVIN D LOVE FWY STE 207
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City | DALLAS
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State | TX
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Zip | 75237-3155
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Country | US
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Telephone | 469-709-8237
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Fax | 214-387-1161
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MRS. ANDREA C BEAVERS
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Credential | PA-C
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Telephone | 469-709-8237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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