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General NPI Number Information
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NPI Number | 1497436000
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Entity Type | Organization
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Legal Business Name | WOUND REJUVENATION
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 19022 APPLETREE HILL LN
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City | HOUSTON
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State | TX
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Zip | 77084-5596
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Country | US
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Telephone | 724-984-7093
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Fax |
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Provider Business Mailing Address
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Address Line | 19022 APPLETREE HILL LN
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City | HOUSTON
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State | TX
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Zip | 77084-5596
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Country | US
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Telephone | 724-984-7093
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TIFFANY L LOPEZ
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Credential | ADULT- GERIATRIC NP
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Telephone | 724-984-7093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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