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General NPI Number Information
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NPI Number | 1417107426
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Entity Type | Organization
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Legal Business Name | WELLNESS CLINIC, P.A.
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 09/25/2008
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Provider Practice Location Address
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Address Line | 1515 N COCKRELL HILL RD STE 113
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City | DALLAS
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State | TX
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Zip | 75211-1315
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Country | US
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Telephone | 214-339-9090
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Fax | 214-339-9023
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Provider Business Mailing Address
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Address Line | 1515 N COCKRELL HILL RD STE 113
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City | DALLAS
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State | TX
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Zip | 75211-1315
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Country | US
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Telephone | 214-339-9090
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Fax | 214-339-9023
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Authorized Official
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Title or Position | DIRECTOR
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Name | JUAN FRANCISCO QUIROZ
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Credential | M.D.
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Telephone | 214-339-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K2264
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License Number State | TX
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