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General NPI Number Information
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NPI Number | 1689740656
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Entity Type | Organization
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Legal Business Name | MESOBELLA
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 731 E SOUTHLAKE BLVD # 180
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6377
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Country | US
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Telephone | 817-251-6376
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Fax |
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Provider Business Mailing Address
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Address Line | 731 E SOUTHLAKE BLVD # 180
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6377
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Country | US
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Telephone | 817-251-6376
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRINA LANZA
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Credential | RN,WOCN,MSN,FNP
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Telephone | 817-291-5780
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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 | 583243
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License Number State | TX
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