Provider Demographics
NPI:1962044412
Name:CHIFOM ENTERPRISES INC
Entity Type:Organization
Organization Name:CHIFOM ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-707-0877
Mailing Address - Street 1:1324 N GALLOWAY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2440
Mailing Address - Country:US
Mailing Address - Phone:972-707-0877
Mailing Address - Fax:972-807-6088
Practice Address - Street 1:1324 N GALLOWAY AVE STE 105
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2440
Practice Address - Country:US
Practice Address - Phone:972-707-0877
Practice Address - Fax:972-807-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty