Healthcare Provider Details

I. General information

NPI: 1962807776
Provider Name (Legal Business Name): PEDIATRIC CARE OF AUSTIN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 JAMES CASEY ST SUITE A150
AUSTIN TX
78745-3369
US

IV. Provider business mailing address

4007 JAMES CASEY ST SUITE A150
AUSTIN TX
78745-3369
US

V. Phone/Fax

Practice location:
  • Phone: 512-447-0707
  • Fax: 512-447-7220
Mailing address:
  • Phone: 512-447-0707
  • Fax: 512-447-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF3737
License Number StateTX

VIII. Authorized Official

Name: RODOLFO BARRERA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 512-478-4939