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General NPI Number Information
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NPI Number | 1679061196
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Entity Type | Individual
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Provider Name | ALICE FA
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Gender | Female
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Dates
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Enumeration Date | 04/30/2018
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 5757 WARREN PKWY STE 210
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City | FRISCO
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State | TX
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Zip | 75034-4777
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Country | US
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Telephone | 972-731-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 5115 AMBERGATE LN
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City | DALLAS
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State | TX
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Zip | 75287-5405
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Country | US
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Telephone | 214-490-0980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | T9102
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License Number State | TX
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