Organization
ROYAL HAVEN MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAIDAMOYO WAGONEKA (OWNER)
(817) 400-0433
Entity
Organization
Contact information
Practice address
2384 HIGHWAY 287 N STE 216, MANSFIELD, TX 76063-9207
(817) 400-0433
(817) 415-6595
Mailing address
2384 HIGHWAY 287 N STE 216, MANSFIELD, TX 76063-9207
(817) 400-0433
(817) 415-6595
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/14/2020
Last updated
06/10/2025
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