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General NPI Number Information
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NPI Number | 1649921628
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Entity Type | Organization
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Legal Business Name | MARVEL MOBILE LAB
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 3704 CLIFFSTONE WAY
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City | MCKINNEY
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State | TX
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Zip | 75070-7383
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Country | US
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Telephone | 469-231-8733
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Fax |
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Provider Business Mailing Address
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Address Line | 3704 CLIFFSTONE WAY
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City | MCKINNEY
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State | TX
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Zip | 75070-7383
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Country | US
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Telephone | 469-231-8733
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MONALISA KAMABNJE
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Credential | AGNP
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Telephone | 469-231-8733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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