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General NPI Number Information
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NPI Number | 1417689944
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Entity Type | Organization
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Legal Business Name | PREMIER WELLNESS CENTER PLLC
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Dates
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Enumeration Date | 06/24/2022
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Last Update Date | 06/24/2022
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Provider Practice Location Address
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Address Line | 4424 S MCCOLL RD
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City | EDINBURG
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State | TX
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Zip | 78539-9608
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Country | US
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Telephone | 956-322-5292
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Fax | 956-322-8718
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Provider Business Mailing Address
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Address Line | 4424 S MCCOLL RD
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City | EDINBURG
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State | TX
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Zip | 78539-9608
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Country | US
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Telephone | 956-322-5292
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Fax | 956-322-8718
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Authorized Official
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Title or Position | OWNER/ PHYSICIAN
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Name | DR. THIENDELLA DIAGNE
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Credential | MD
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Telephone | 956-800-4378
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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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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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