1508391244 NPI number — TONDALA LATRECE COMPANY ENTERPRISE,LLC

Table of content: (NPI 1508391244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508391244 NPI number — TONDALA LATRECE COMPANY ENTERPRISE,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TONDALA LATRECE COMPANY ENTERPRISE,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508391244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8811 TEEL PKWY
Provider Second Line Business Mailing Address:
SUITE 100-5222
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-577-8664
Provider Business Mailing Address Fax Number:
214-305-6911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9103 ARISTOCRAT LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75033-7176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-577-8664
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FOWLER
Authorized Official First Name:
TONDALA
Authorized Official Middle Name:
LATRECE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-577-8664

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  14692890 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com