Healthcare Provider Details

I. General information

NPI: 1588651681
Provider Name (Legal Business Name): PEARLAND PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 BROADWAY ST # A
PEARLAND TX
77581-5501
US

IV. Provider business mailing address

2017 BROADWAY ST # A
PEARLAND TX
77581-5501
US

V. Phone/Fax

Practice location:
  • Phone: 281-485-9990
  • Fax: 281-485-9469
Mailing address:
  • Phone: 281-485-9990
  • Fax: 281-485-9469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRYSTAL SWAGGARD
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 281-485-9990