Healthcare Provider Details

I. General information

NPI: 1790973642
Provider Name (Legal Business Name): LAREDO PEDIATRICS & NEONATOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 JAIME ZAPATA MEMORIAL HWY SUITE 5
LAREDO TX
78043-4769
US

IV. Provider business mailing address

3507 JAIME ZAPATA MEMORIAL HWY SUITE 5
LAREDO TX
78043-4769
US

V. Phone/Fax

Practice location:
  • Phone: 956-726-9252
  • Fax: 956-753-3442
Mailing address:
  • Phone: 956-726-9252
  • Fax: 956-753-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH5507
License Number StateTX

VIII. Authorized Official

Name: FRANCISCO JAVIER CERVANTES
Title or Position: OWNER
Credential: MD
Phone: 956-726-9252