Healthcare Provider Details

I. General information

NPI: 1497626816
Provider Name (Legal Business Name): TLC PEDIATRICS OF AMARILLO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 S SONCY RD STE 102
AMARILLO TX
79119-6405
US

IV. Provider business mailing address

3501 S SONCY RD STE 102
AMARILLO TX
79119-6405
US

V. Phone/Fax

Practice location:
  • Phone: 806-353-7900
  • Fax: 806-353-8321
Mailing address:
  • Phone: 806-353-7900
  • Fax: 806-353-8321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGIE CORONADO
Title or Position: OFFICE MANAGER
Credential:
Phone: 806-353-7900