Individual
LONG CUU CONG TA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4500 S LANCASTER RD, DALLAS, TX 75216-7167
(512) 466-0836
Mailing address
1413 VANDERBILT ST E APT 707, FORT WORTH, TX 76120-4942
(512) 466-0836
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
744105
TX
Other
Enumeration date
01/14/2013
Last updated
01/14/2013
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