Basic Information
| Provider Information | |||||||||
| NPI: | 1407079965 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULLINAX | ||||||||
| FirstName: | DELORES | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 OLDE TOWNE DR | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750616155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727905139 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1353 N WESTMORELAND RD | ||||||||
| Address2: | BLDG. F | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752111655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2143337063 | ||||||||
| FaxNumber: | 2143337097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 101074 | TX | Y | Other Service Providers | Specialist |
No ID Information.