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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

SOUTHLAKE GYN AND WELLNESS CENTER, PLLC
NPI 1649700808
Obstetrics & Gynecology in Grapevine, TX

Active since June 19, 2017CLIA 45D2165989 · Waiver
220 N PARK BLVD STE 100, GRAPEVINE, TX 76051(817) 280-9616(817) 722-6328 Get Directions Write a Review

NPPES record last updated: July 21, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jul 21, 2026, Jun 11, 2019, May 28, 2019 and 2 more (5 updates tracked since 2017).

About Southlake Gyn And Wellness Center, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHLAKE GYN AND WELLNESS CENTER, PLLC (NPI 1649700808) is a healthcare organization registered as an obstetrics & gynecology in Grapevine, Texas and active in the NPI registry since June 2017. The organization holds a CLIA Waiver certificate valid through May 8, 2027 and lists Miriam M Torres, Owner, as its authorized official.

NPPES Registry Identity

NPI1649700808
Entity TypeOrganization
Primary Taxonomy207V00000X
Legal Business NameSOUTHLAKE GYN AND WELLNESS CENTER, PLLC
Location Address220 N PARK BLVD STE 100Grapevine, TX 76051-6900
Mailing Address431 E State Highway 114 Ste 380Southlake, TX 76092-4414 · (817) 280-9616 · Fax (817) 722-6328
Phone(817) 280-9616
Fax(817) 722-6328
Organization SubpartNo
Authorized OfficialMiriam M TorresOwner · (817) 280-9616
Enumeration DateJune 19, 2017
Last NPPES UpdateJuly 21, 20265 updates tracked since enumeration
NPPES CertifiedJuly 21, 2026
✔ NPI 1649700808 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
Licenses✔ Licensed in TX · N1926✔ Licensed in KY · 41197
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
220 N PARK BLVD STE 100, Grapevine, TX 76051
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 45D2165989

Southlake Gynand Wellness · Grapevine, TX
Active · expires May 8, 2027
CLIA Number45D2165989
Laboratory TypePhysician Office
Certificate Effective DateMay 9, 2025
Certificate Expiration DateMay 8, 2027
Laboratory DirectorMinam M. Torres
Laboratory Phone(817) 280-9616
Laboratory LocationSouthlake Gynand Wellness220 N Park Blvd Suite 100, Grapevine, TX 76051
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. PEDRO JUAN LOREDO III MD
Surgery (Surgery of the Hand)
220 N PARK BLVD STE 100
GRAPEVINE, TX 76051
Tarrant County (972) 939-4974
MIRIAM M. TORRES M.D.
Obstetrics & Gynecology
220 N PARK BLVD STE 100
GRAPEVINE, TX 76051
Tarrant County (817) 280-9616

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southlake Gyn And Wellness Center, PLLC's NPI number?

The NPI number for Southlake Gyn And Wellness Center, PLLC is 1649700808. It was assigned to this organization in the NPPES registry on June 19, 2017.

Where is Southlake Gyn And Wellness Center, PLLC located?

Southlake Gyn And Wellness Center, PLLC is located at 220 N Park Blvd Ste 100, Grapevine, TX 76051. The listed phone number is (817) 280-9616.

What is Southlake Gyn And Wellness Center, PLLC's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Does Southlake Gyn And Wellness Center, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2165989) is associated with this NPI, valid through May 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Southlake Gyn And Wellness Center, PLLC was last updated on July 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.