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General NPI Number Information
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NPI Number | 1861231300
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Entity Type | Organization
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Legal Business Name | BALANCE WOUND CARE TX, LLC
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 6320 EDGEMERE BLVD STE 22
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City | EL PASO
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State | TX
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Zip | 79925-3517
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Country | US
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Telephone | 915-335-1977
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Fax | 915-591-2801
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Provider Business Mailing Address
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Address Line | 9564 VERBENA DR
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City | EL PASO
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State | TX
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Zip | 79924-6226
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Country | US
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Telephone | 915-335-1977
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Fax | 915-591-2801
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Authorized Official
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Title or Position | OWNER
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Name | ANA L MORADO
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Credential |
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Telephone | 915-335-1977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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