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General NPI Number Information
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NPI Number | 1861214694
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Entity Type | Individual
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Provider Name | JORDI BOSTOCK
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 3050 PAINTED LAKE CIR APT 210
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City | THE COLONY
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State | TX
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Zip | 75056-4788
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Country | US
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Telephone | 214-529-8031
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Fax |
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Provider Business Mailing Address
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Address Line | 18484 PRESTON RD
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City | DALLAS
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State | TX
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Zip | 75252-5400
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 1459956
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License Number State | TX
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