Provider Demographics
NPI:1366635708
Name:WOMEN'S WELLNESS CENTER AT WHITE ROCK
Entity Type:Organization
Organization Name:WOMEN'S WELLNESS CENTER AT WHITE ROCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-324-2401
Mailing Address - Street 1:1151 N BUCKNER BLVD
Mailing Address - Street 2:#301A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3426
Mailing Address - Country:US
Mailing Address - Phone:214-324-2401
Mailing Address - Fax:214-321-5052
Practice Address - Street 1:1151 N BUCKNER BLVD
Practice Address - Street 2:#301A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3426
Practice Address - Country:US
Practice Address - Phone:214-324-2401
Practice Address - Fax:214-321-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1163207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00297ZMedicare PIN
TXI38791Medicare UPIN