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General NPI Number Information
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NPI Number | 1457412710
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Entity Type | Organization
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Legal Business Name | ANGEL'S STAR WELLNESS CENTER, P.A
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 8325 WHITLEY RD SUITE: 100
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City | WATAUGA
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State | TX
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Zip | 76148-2487
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Country | US
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Telephone | 817-479-1181
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Fax | 817-918-4432
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Provider Business Mailing Address
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Address Line | 8325 WHITLEY RD SUITE: 100
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City | WATAUGA
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State | TX
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Zip | 76148-2487
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Country | US
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Telephone | 817-479-1181
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Fax | 817-750-2789
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Authorized Official
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Title or Position | MANAGEMENT
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Name | FRANK NGUYEN
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Credential |
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Telephone | 817-791-1811
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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 | L0508
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License Number State | TX
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