| Lifevantage House Calls Pllc | |
|
9101 Nightingale Dr Fort Worth TX 76123-2713 | |
| (817) 739-4007 | |
| Not Available |
| Full Name | Lifevantage House Calls Pllc |
|---|---|
| Speciality | General Practice |
| Location | 9101 Nightingale Dr, Fort Worth, Texas |
| Authorized Official Name and Position | Raymond Andrada (OWNER) |
| Authorized Official Contact | 8177394007 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifevantage House Calls Pllc 9101 Nightingale Dr Fort Worth TX 76123-2713 Ph: (817) 739-4007 | Lifevantage House Calls Pllc 9101 Nightingale Dr Fort Worth TX 76123-2713 Ph: (817) 739-4007 |
| NPI Number | 1679963771 |
|---|---|
| Provider Enumeration Date | 01/27/2015 |
| Last Update Date | 01/27/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679963771 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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