=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699274779
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYNAPTIC TECHNOLOGIES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2018
-----------------------------------------------------
Last Update Date | 02/05/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3400 WATERVIEW PKWY STE 305
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-1566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-551-0257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 WATERVIEW PKWY STE 305
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75080-1566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-551-0257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CARMEN DAVILA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-551-0257
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------