Organization
1 CP PLACE PLLC
Active
Organization
1 CP PLACE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JANICE ELAINE BRUNSTROM-HERNANDEZ M.D. (MANAGING MEMBER/ DIRECTOR)
(314) 223-3306
Entity
Organization
Contact information
Practice address
7709 SAN JACINTO PL, SUITE 203, PLANO, TX 75024-3215
(469) 331-0030
Mailing address
PO BOX 251665, PLANO, TX 75025-1515
(469) 331-0030
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
M5074
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339119501
—
TX
Enumeration date
09/09/2014
Last updated
01/15/2016
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