Provider Demographics
NPI:1902232192
Name:DFW WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:DFW WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-317-4666
Mailing Address - Street 1:4516 LOVERS LN
Mailing Address - Street 2:SUITE 331
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6925
Mailing Address - Country:US
Mailing Address - Phone:214-317-4666
Mailing Address - Fax:214-317-4667
Practice Address - Street 1:4516 LOVERS LN
Practice Address - Street 2:SUITE 331
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6925
Practice Address - Country:US
Practice Address - Phone:214-317-4666
Practice Address - Fax:214-317-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty