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General NPI Number Information
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NPI Number | 1760131601
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Entity Type | Organization
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Legal Business Name | PM VITAS LLC
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Dates
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Enumeration Date | 03/19/2022
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 1018 E IRVING BLVD
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City | IRVING
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State | TX
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Zip | 75060-4351
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Country | US
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Telephone | 469-471-1539
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Fax | 469-654-4091
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Provider Business Mailing Address
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Address Line | 2639 WALNUT HILL LN STE 225
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City | DALLAS
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State | TX
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Zip | 75229-5699
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | WILLIAM HERNANDEZ LEYVA
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Credential |
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Telephone | 786-603-9409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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