Healthcare Provider Details

I. General information

NPI: 1417578501
Provider Name (Legal Business Name): PEDS CENTER OF ROUND ROCK PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MEDICAL PKWY STE 310
CEDAR PARK TX
78613-2529
US

IV. Provider business mailing address

7700 CAT HOLLOW DR STE 104
ROUND ROCK TX
78681-5797
US

V. Phone/Fax

Practice location:
  • Phone: 512-523-5535
  • Fax: 512-281-5373
Mailing address:
  • Phone: 512-476-5437
  • Fax: 512-244-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIVEKANAND DASARI
Title or Position: OWNER
Credential: MD
Phone: 512-868-1762