Individual
AUGUSTINE NUBEA FOMBON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
601 S GREAT SOUTHWEST PKWY STE 106, GRAND PRAIRIE, TX 75051-1057
(214) 718-9593
Mailing address
601 S GREAT SOUTHWEST PKWY STE 106, GRAND PRAIRIE, TX 75051-1057
(214) 718-9593
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
11/14/2019
Last updated
10/27/2020
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