Provider Demographics
NPI:1194180034
Name:XENIA MARADIAGA
Entity Type:Organization
Organization Name:XENIA MARADIAGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:XENIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARADIAGA-GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:512-563-8959
Mailing Address - Street 1:6550 SHADY BROOK LN
Mailing Address - Street 2:APT 312
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1203
Mailing Address - Country:US
Mailing Address - Phone:512-563-8959
Mailing Address - Fax:
Practice Address - Street 1:7910 COLLIN MCKINNEY PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-2659
Practice Address - Country:US
Practice Address - Phone:512-563-8959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01230171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty