Provider Demographics
NPI:1669830345
Name:HORMONAL HEALTH AND WELLNESS CENTERS
Entity Type:Organization
Organization Name:HORMONAL HEALTH AND WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:JENAI
Authorized Official - Last Name:SURESH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:214-202-4727
Mailing Address - Street 1:620 N KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6855
Mailing Address - Country:US
Mailing Address - Phone:469-402-1877
Mailing Address - Fax:
Practice Address - Street 1:1207 ARISTA DR
Practice Address - Street 2:STE 103
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-6657
Practice Address - Country:US
Practice Address - Phone:469-402-1877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical