Healthcare Provider Details

I. General information

NPI: 1275906356
Provider Name (Legal Business Name): COMPREHENSIVE PEDIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2015
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2379 GUS THOMASSON RD #200
MESQUITE TX
75150-5302
US

IV. Provider business mailing address

6044 E LOVERS LN #8107
DALLAS TX
75206-4371
US

V. Phone/Fax

Practice location:
  • Phone: 585-880-0414
  • Fax:
Mailing address:
  • Phone: 585-880-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberQ2566
License Number StateTX

VIII. Authorized Official

Name: DR. MEENU M JINDAL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 585-880-0414