Individual
DALE PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CERTPS
Contact information
Practice address
1545 W MOCKINGBIRD LN, SUITE 3005, DALLAS, TX 75235-5014
(214) 819-9911
(214) 819-9944
Mailing address
1545 W MOCKINGBIRD LN, SUITE 3005, DALLAS, TX 75235-5014
(214) 819-9911
(214) 819-9944
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
05/30/2008
Last updated
05/30/2008
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