Healthcare Provider Details

I. General information

NPI: 1700530441
Provider Name (Legal Business Name): TCH PEDIATRIC ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6623 W CROSS CREEK BEND LN
FULSHEAR TX
77441-2225
US

IV. Provider business mailing address

1919 S BRAESWOOD BLVD FL 5
HOUSTON TX
77030-4444
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-2999
  • Fax:
Mailing address:
  • Phone: 832-824-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAURA VILLAR
Title or Position: MANAGER
Credential:
Phone: 832-824-2999