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General NPI Number Information
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NPI Number | 1427754241
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Entity Type | Organization
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Legal Business Name | K.P. EZICHI
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Dates
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Enumeration Date | 02/02/2023
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Last Update Date | 02/02/2023
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Provider Practice Location Address
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Address Line | 14665 PRESTON RD
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City | DALLAS
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State | TX
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Zip | 75254-7880
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Country | US
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Telephone | 817-290-4225
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Fax |
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Provider Business Mailing Address
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Address Line | 14665 PRESTON RD
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City | DALLAS
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State | TX
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Zip | 75254-7880
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Country | US
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Telephone | 817-290-4225
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Fax |
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Authorized Official
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Title or Position | STAFF
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Name | K.P. EZICHI
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Credential | PSY,MD
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Telephone | 817-290-4225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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