Organization
COLLEYVILLE BODY FOCUS WELLNESS CLINIC, LLC
Active
Other names
Juvia Med Spa
Organization subpart
No
Provider details
NPI number
Authorized official
CHERI DAVUS (CREDENTIALING MANAGER)
(972) 792-5700
Entity
Organization
Contact information
Practice address
4620 COLLEYVILLE BLVD, STE 102, COLLEYVILLE, TX 76034-3971
(817) 427-3700
Mailing address
9101 LBJ FWY, STE 710, DALLAS, TX 75243-2057
(972) 792-5700
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
N5550
TX
208VP0000X
Pain Medicine Physician
N5550
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N5550
TMB
TX
Enumeration date
12/07/2015
Last updated
12/07/2015
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