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Organization
UT SOUTHWESTERN
Active
Organization
UT SOUTHWESTERN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TEGA DANIEL DIEJOMAOH (MEDICAL STUDENT)
(361) 585-3472
Entity
Organization
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-9006
(214) 648-2168
Mailing address
5323 HARRY HINES BLVD, DALLAS, TX 75390-9006
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
06/15/2023
Last updated
06/15/2023
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