Basic Information
| Provider Information | |||||||||
| NPI: | 1275996860 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOORSTEP PROCARE MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12035 SHILOH RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752281507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722892273 | ||||||||
| FaxNumber: | 9722851396 | ||||||||
| Practice Location | |||||||||
| Address1: | 12035 SHILOH RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752281507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722892273 | ||||||||
| FaxNumber: | 9722851396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2016 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | MENDIOLA | ||||||||
| AuthorizedOfficialFirstName: | JESSIE | ||||||||
| AuthorizedOfficialMiddleName: | GARZON | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4694384493 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 3633174 | 05 | TX | MEDICAID |