Healthcare Provider Details

I. General information

NPI: 1467673301
Provider Name (Legal Business Name): PCP ASSOCIATES OF PASADENA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 WOODLAWN AVE SUITE 150
PASADENA TX
77504
US

IV. Provider business mailing address

4102 WOODLAWN AVE SUITE 150
PASADENA TX
77504
US

V. Phone/Fax

Practice location:
  • Phone: 713-943-8229
  • Fax: 713-943-9608
Mailing address:
  • Phone: 713-943-8229
  • Fax: 713-943-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DEEPAK PATTANAIK
Title or Position: PRESIDENT
Credential: MD
Phone: 713-943-8229