Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Southlake GYN and Wellness Center, PLLC

Organization Obstetrics & Gynecology Physician · NPI 1649700808

Southlake GYN and Wellness Center, PLLC is an Obstetrics & Gynecology Physician in Grapevine, Texas. Licensed in Kentucky and Texas. Registered with an NPI since 2017.

Licensed in
KY, TX
In the registry since
2017
Specialties on file
2
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

220 N Park Blvd Ste 100
Grapevine, TX 76051-6900
Phone: (817) 280-9616
Fax: (817) 722-6328
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Obstetrics & Gynecology Physician (primary) Taxonomy 207V00000X · Licence N1926 (TX)
Obstetrics & Gynecology Physician Taxonomy 207V00000X · Licence 41197 (KY)

Record details

NPI number1649700808
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Miriam Torres — Owner · (817) 280-9616
NPI enumeratedJune 19, 2017
Last updated in NPPESJuly 21, 2026
Certification dateJuly 21, 2026
Mailing address431 E State Highway 114 Ste 380, Southlake, TX 76092-4414

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