Healthcare Provider Details

I. General information

NPI: 1033767975
Provider Name (Legal Business Name): PEDS CENTER OF ROUND ROCK PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W US HIGHWAY 290
ELGIN TX
78621-3265
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 512-281-1900
  • Fax: 512-285-4100
Mailing address:
  • Phone: 512-733-5437
  • 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: MR. VIVEKANAND DASARI
Title or Position: OWNER
Credential: MD
Phone: 512-733-5437