Organization
LE REVE ANTI-AGING AND WEIGHT LOSS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON TINLEY MD (PRINCIPAL)
(682) 703-1400
Entity
Organization
Contact information
Practice address
7000 BRYANT IRVIN RD, STE 108, FORT WORTH, TX 76132-4250
(682) 703-1400
(817) 887-5779
Mailing address
7000 BRYANT IRVIN RD, STE 108, FORT WORTH, TX 76132-4250
(682) 703-1400
(817) 887-5779
Taxonomy
Speciality
Code
Description
License number
State
261QC1800X
Corporate Health Clinic/Center
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
04/11/2016
Last updated
04/11/2016
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