Provider Demographics
NPI:1881233633
Name:TEXAS INFUSION GROUP PLLC
Entity type:Organization
Organization Name:TEXAS INFUSION GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGANZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-341-4786
Mailing Address - Street 1:5020 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-0308
Mailing Address - Country:US
Mailing Address - Phone:310-740-7864
Mailing Address - Fax:
Practice Address - Street 1:910 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2409
Practice Address - Country:US
Practice Address - Phone:310-740-7864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-26
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center