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General NPI Number Information
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NPI Number | 1417636770
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Entity Type | Organization
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Legal Business Name | LIBERTY FAMILY CARE AND WELLNESS PLLC
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Dates
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Enumeration Date | 07/13/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 8701 LIBERTY GROVE RD STE 100
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City | ROWLETT
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State | TX
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Zip | 75089-2305
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Country | US
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Telephone | 972-408-6433
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 LIBERTY GROVE RD STE 100
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City | ROWLETT
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State | TX
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Zip | 75089-2305
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Country | US
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Telephone | 972-348-0046
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Fax | 972-257-1885
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Authorized Official
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Title or Position | MANAGER
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Name | LAURA CERVANTES
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Credential | APRN
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Telephone | 972-348-0046
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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 |
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License Number State |
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