Organization
EUDAIMONIA NEUROLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUGUSTO C LASTIMOSA I M.D. (PRESIDENT)
(817) 908-8124
Entity
Organization
Contact information
Practice address
500 THROCKMORTON STREET, UNIT 3309, FORT WORTH, TX 76102
(817) 908-8124
(817) 885-7339
Mailing address
500 THROCKMORTON STREET, UNIT 3309, FORT WORTH, TX 76102
(817) 908-8124
(817) 885-7339
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
F0555
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122935309
—
TX
Enumeration date
11/13/2007
Last updated
05/13/2020
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