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General NPI Number Information
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NPI Number | 1861753733
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Entity Type | Organization
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Legal Business Name | TEXAS COMPREHENSIVE HEALTHCARE SERVICES, PLLC
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Dates
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Enumeration Date | 06/06/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 5550 LBJ FWY, STE 150
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City | DALLAS
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State | TX
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Zip | 75240-6217
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Country | US
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Telephone | 972-596-3018
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 260516
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City | PLANO
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State | TX
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Zip | 75026-0516
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Country | US
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Telephone | 972-596-3018
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | VICTOR GONZALEZ
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Credential | MD
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Telephone | 972-596-3018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA07507
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M4104
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License Number State | TX
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