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General NPI Number Information
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NPI Number | 1962044412
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Entity Type | Organization
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Legal Business Name | CHIFOM ENTERPRISES INC
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 1324 N GALLOWAY AVE STE 105
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City | MESQUITE
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State | TX
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Zip | 75149-2440
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Country | US
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Telephone | 972-707-0877
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Fax | 972-807-6088
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Provider Business Mailing Address
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Address Line | 1324 N GALLOWAY AVE STE 105
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City | MESQUITE
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State | TX
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Zip | 75149-2440
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Country | US
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Telephone | 972-707-0877
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Fax | 972-807-6088
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHANIE MENES
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Credential | MD
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Telephone | 972-707-0877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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