Organization
ATIVA HEALTH CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. YULIA POLIKHOVA (OWNER)
(817) 536-0219
Entity
Organization
Contact information
Practice address
3510 E LANCASTER AVE, SUITE B, FORT WORTH, TX 76103-2555
(817) 536-0219
(817) 536-0311
Mailing address
3510 E LANCASTER AVE, SUITE B, FORT WORTH, TX 76103-2555
(817) 536-0219
(817) 536-0311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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