Healthcare Provider Details

I. General information

NPI: 1215139340
Provider Name (Legal Business Name): PEDIATRIC AND ENDOCRINOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17115 RED OAK DRIVE SUITE 120
HOUSTON TX
77090-2641
US

IV. Provider business mailing address

17115 RED OAK DRIVE SUITE 120
HOUSTON TX
77090-2607
US

V. Phone/Fax

Practice location:
  • Phone: 281-781-8144
  • Fax: 281-781-8853
Mailing address:
  • Phone: 281-781-8144
  • Fax: 281-781-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NAILA YUNUS SOORTY
Title or Position: MD
Credential: MD
Phone: 281-781-8144