MEDICARE: LA PROVIDENCE PEDIATRIC AND FAMILY CLINICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	N1405	TX

General Provider Information

NPI Number	:	1922400043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA PROVIDENCE PEDIATRIC AND FAMILY CLINICS

Provider Business Mailing Address
First Line	:	9900 S GESSNER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1008
Country	:	US
Telephone Number	:	713-981-6002
Fax Number	:	713-909-6002

Provider Business Practice Location Address
First Line	:	9900 S GESSNER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-1008
Country	:	US
Telephone Number	:	713-981-6002
Fax Number	:	713-909-6002

Authorized Official
Title or Position	:	OWNER
Name	:	DR. IFEYINWA ONWUDIWE
Credential	:	MD
Telephone Number	:	713-981-6002

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	03/10/2015

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