Basic Information
Provider Information
NPI: 1619433034
EntityType: 2
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OrganizationName: MARIPOSA PERINATAL SERVICES PLLC
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Mailing Information
Address1: 9330 LBJ FWY STE 800
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City: DALLAS
State: TX
PostalCode: 752434310
CountryCode: US
TelephoneNumber: 9727925700
FaxNumber: 2145061170
Practice Location
Address1: 1510 W. HWY 287 BYPASS
Address2: STE. 100
City: WAXAHACHIE
State: TX
PostalCode: 75165
CountryCode: US
TelephoneNumber: 9729053778
FaxNumber: 8442135189
Other Information
ProviderEnumerationDate: 02/11/2019
LastUpdateDate: 10/06/2020
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AuthorizedOfficialLastName: PREDANIC
AuthorizedOfficialFirstName: MLADEN
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AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 2145062617
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate: 10/06/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VM0101X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine

No ID Information.


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