Healthcare Provider Details

I. General information

NPI: 1477979367
Provider Name (Legal Business Name): PEDIATRIC ANESTHESIA ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2014
Last Update Date: 03/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

10830 N CENTRAL EXPY CENTRAL SQUARE SUITE 120
DALLAS TX
75231-1050
US

V. Phone/Fax

Practice location:
  • Phone: 214-378-9898
  • Fax: 214-378-9888
Mailing address:
  • Phone: 214-378-9898
  • Fax: 214-378-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. MARIA E ORTEGA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-378-9898