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General NPI Number Information
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NPI Number | 1447950621
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Entity Type | Organization
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Legal Business Name | RADIANT MUSE HEALTH & WELLNESS
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Dates
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Enumeration Date | 03/07/2023
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 737 NEWPORT DR
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City | MANSFIELD
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State | TX
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Zip | 76063-2816
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Country | US
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Telephone | 254-370-6802
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Fax |
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Provider Business Mailing Address
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Address Line | 737 NEWPORT DR
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City | MANSFIELD
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State | TX
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Zip | 76063-2816
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Country | US
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Telephone | 254-370-6802
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DIAMOND FORD
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Credential |
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Telephone | 254-370-6802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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