Healthcare Provider Details

I. General information

NPI: 1053574541
Provider Name (Legal Business Name): HORIZON CITY PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2008
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14505 HORIZON BLVD
HORIZON TX
79928-8564
US

IV. Provider business mailing address

14505 HORIZON BLVD
HORIZON TX
79928-8564
US

V. Phone/Fax

Practice location:
  • Phone: 915-852-4089
  • Fax: 915-852-2031
Mailing address:
  • Phone: 915-852-4089
  • Fax: 915-852-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RODIN MENDOZA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 915-852-4089