Organization
SOUTHLAKE GYN AND WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIRIAM M TORRES MD (OWNER)
(817) 280-9616
Entity
Organization
Contact information
Practice address
220 N PARK BLVD STE 100, GRAPEVINE, TX 76051-6900
(817) 280-9616
(817) 722-6328
Mailing address
202 71 PARK BLVD, #100, GRAPEVINE, TX 76051
(817) 280-9616
(817) 722-6328
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
41197
KY
207V00000X
Obstetrics & Gynecology Physician
Primary
N1926
TX
Other
Enumeration date
06/19/2017
Last updated
06/11/2019
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