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General NPI Number Information
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NPI Number | 1760465173
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Entity Type | Organization
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Legal Business Name | TEXAS WELLNESS HEALTH GROUP, PLLC
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 3001 N 23RD ST STE 1
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City | MCALLEN
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State | TX
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Zip | 78501-6179
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Country | US
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Telephone | 956-581-2168
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Fax | 956-581-2169
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Provider Business Mailing Address
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Address Line | 5208 N 10TH ST # 4016
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City | MCALLEN
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State | TX
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Zip | 78504-2701
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Country | US
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Telephone | 956-581-2168
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Fax | 956-581-2169
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Authorized Official
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Title or Position | MANAGER
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Name | JORGE MIRANDA
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Credential | MD
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Telephone | 956-581-2168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | J2458
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License Number State | TX
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