=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457097735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DL WELLNESS PARTNERS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2022
-----------------------------------------------------
Last Update Date | 05/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16868 HIGHWAY 3
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77598-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-572-0151
-----------------------------------------------------
Fax | 281-603-0605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16868 HIGHWAY 3
-----------------------------------------------------
City | WEBSTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77598-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-808-5936
-----------------------------------------------------
Fax | 281-603-0605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MR. DAVID VINCENT HOPKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-572-0151
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------