| Organization Name: | LIFEVANTAGE HOUSE CALLS PLLC |
| NPI Number: | 1679963771 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAYMOND ANDRADA (OWNER) |
| Mailing Address: | 9101 Nightingale Dr Fort Worth |
| State: | TX US |
| Postal Code: | 761232713 |
| Phone Number: | 8177394007 |
| Fax Number: | |
| NPI Enumeration Date: | 01/27/2015 |
| NPI Last Update Date: | 01/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
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Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |