Healthcare Provider Details

I. General information

NPI: 1184873689
Provider Name (Legal Business Name): GENDI PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 09/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 PASADENA BLVD STE A
PASADENA TX
77502-2414
US

IV. Provider business mailing address

1430 PASADENA BLVD STE A
PASADENA TX
77502-2414
US

V. Phone/Fax

Practice location:
  • Phone: 713-477-0400
  • Fax: 713-477-2711
Mailing address:
  • Phone: 713-477-0400
  • Fax: 713-477-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ9680
License Number StateTX

VIII. Authorized Official

Name: WAGIH GENDI
Title or Position: MD
Credential:
Phone: 713-477-0400