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General NPI Number Information
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NPI Number | 1720786726
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Entity Type | Organization
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Legal Business Name | PURA VITALITY LLC
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 4910 WILLOWBEND BLVD STE A
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City | HOUSTON
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State | TX
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Zip | 77035-3227
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Country | US
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Telephone | 678-770-5542
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Fax |
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Provider Business Mailing Address
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Address Line | 4910 WILLOWBEND BLVD STE A
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City | HOUSTON
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State | TX
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Zip | 77035-3227
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Country | US
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Telephone | 678-770-5542
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | DR. TAHERA ENGLISH
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Credential | NURSE PRACTITIONER
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Telephone | 678-770-5542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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