Healthcare Provider Details

I. General information

NPI: 1962922633
Provider Name (Legal Business Name): PANDA PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10824 E CRYSTAL FALLS PKWY STE 201
LEANDER TX
78641-4301
US

IV. Provider business mailing address

10824 E CRYSTAL FALLS PKWY STE 201
LEANDER TX
78641-4301
US

V. Phone/Fax

Practice location:
  • Phone: 512-528-6100
  • Fax: 512-528-6200
Mailing address:
  • Phone: 512-528-6100
  • Fax: 512-528-6200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberK7798
License Number StateTX

VIII. Authorized Official

Name: DR. JOANNE RAQUEL LI-PELAEZ
Title or Position: PHYSICIAN/PARTNER
Credential: DO
Phone: 512-528-6100