# UT SOUTHWESTERN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710662093
- **Authorized official:** TEGA DANIEL DIEJOMAOH (MEDICAL STUDENT)
- **Authorized official phone:** (361) 585-3472

## Contact information

- **Practice address:** 5323 HARRY HINES BLVD, DALLAS, TX 75390-9006
- **Practice address phone:** (214) 648-2168
- **Mailing address:** 5323 HARRY HINES BLVD, DALLAS, TX 75390-9006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QS1000X | Student Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/15/2023
- **Last updated:** 06/15/2023