Healthcare Provider Details

I. General information

NPI: 1942068077
Provider Name (Legal Business Name): DINO PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2024
Last Update Date: 02/06/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 SW BIG BEND TRAIL
GLEN ROSE TX
76043-7604
US

IV. Provider business mailing address

2450 COUNTY ROAD 2027
GLEN ROSE TX
76043-1360
US

V. Phone/Fax

Practice location:
  • Phone: 254-635-6236
  • Fax:
Mailing address:
  • Phone: 817-675-5891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIE RAMIREZ
Title or Position: OWNER
Credential: NURSE PRACTITIONER
Phone: 254-635-6236