Healthcare Provider Details

I. General information

NPI: 1588929764
Provider Name (Legal Business Name): SUNNYSIDE PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5817 PATTON ST SUITE 101
CORPUS CHRISTI TX
78414-2428
US

IV. Provider business mailing address

5817 PATTON ST SUITE 101
CORPUS CHRISTI TX
78414-2428
US

V. Phone/Fax

Practice location:
  • Phone: 361-992-9383
  • Fax: 361-992-9543
Mailing address:
  • Phone: 361-992-9383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL9052
License Number StateTX

VIII. Authorized Official

Name: DR. JESSICA I ACEVEDO-GRACIA
Title or Position: OWNER
Credential: MD
Phone: 361-992-9383