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General NPI Number Information
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NPI Number | 1508391244
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Entity Type | Organization
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Legal Business Name | TONDALA LATRECE COMPANY ENTERPRISE,LLC
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 9103 ARISTOCRAT LN
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City | FRISCO
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State | TX
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Zip | 75033-7176
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Country | US
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Telephone | 214-577-8664
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Fax |
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Provider Business Mailing Address
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Address Line | 8811 TEEL PKWY SUITE 100-5222
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City | FRISCO
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State | TX
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Zip | 75035-4201
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Country | US
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Telephone | 214-577-8664
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Fax | 214-305-6911
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Authorized Official
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Title or Position | OWNER
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Name | MRS. TONDALA LATRECE FOWLER
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Credential | B.S.; CAMIS
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Telephone | 214-577-8664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 14692890
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License Number State | TX
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