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General NPI Number Information
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NPI Number | 1902259385
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Entity Type | Organization
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Legal Business Name | EQUINOX CLINIC PLLC
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 3160 N TARRANT PKWY STE 404
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City | FORT WORTH
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State | TX
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Zip | 76177-8614
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Country | US
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Telephone | 972-707-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 1141 N LOOP 1604 E # 105-612
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1339
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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 | MD
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Name | ANDREW ALBERT INDRESANO
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Credential |
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Telephone | 972-707-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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