Individual
HOMER M RELATIVO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
2971 TRAIL LAKE DR, GRAND PRAIRIE, TX 75054-5539
(214) 227-2457
(214) 764-0880
Mailing address
PO BOX 938, ROWLETT, TX 75030-0938
(214) 227-2457
(214) 764-0880
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
11-124
TX
Other
Enumeration date
11/13/2013
Last updated
12/20/2019
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