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NPI Code Detail

MEDICARE: ADOLESCENT AND YOUNG ADULT HEALTH AND WELLNESS

MEDICARE: ADOLESCENT AND YOUNG ADULT HEALTH AND WELLNESS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2208000000XPediatrics Physician

General Provider Information

NPI Number : 1558763086
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADOLESCENT AND YOUNG ADULT HEALTH AND WELLNESS
Provider Business Mailing Address
First Line : 16980 DALLAS PKWY STE 204
Second Line :
City : DALLAS
State : TX
Zip : 75248-1910
Country : US
Telephone Number : 972-733-6565
Fax Number : 972-733-6564
Provider Business Practice Location Address
First Line : 16980 DALLAS PKWY STE 204
Second Line :
City : DALLAS
State : TX
Zip : 75248-1910
Country : US
Telephone Number : 972-733-6565
Fax Number : 972-733-6564
Authorized Official
Title or Position : PRESIDENT
Name : DR. DANA RUBIN-REMER
Credential : M.D.
Telephone Number : 972-733-6565
Provider Enumeration Date : 09/16/2014
Last Update Date : 04/25/2017

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Directions to “ADOLESCENT AND YOUNG ADULT HEALTH AND WELLNESS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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