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General NPI Number Information
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NPI Number | 1497499966
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Entity Type | Organization
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Legal Business Name | MGM HEALTHCARE LLC
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 1205 ANTLER DR
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City | SCHERTZ
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State | TX
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Zip | 78154-1107
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Country | US
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Telephone | 210-906-0374
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 ANTLER DR
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City | SCHERTZ
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State | TX
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Zip | 78154-1107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VERONICA CARDENAS
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Credential |
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Telephone | 213-259-3559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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