Healthcare Provider Details

I. General information

NPI: 1871246710
Provider Name (Legal Business Name): TCH PEDIATRIC ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 12TH ST STE 101
PFLUGERVILLE TX
78660-3814
US

IV. Provider business mailing address

1919 S BRAESWOOD BLVD
HOUSTON TX
77030-4444
US

V. Phone/Fax

Practice location:
  • Phone: 512-989-3334
  • Fax: 512-989-3390
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAURA VILLAR
Title or Position: MANAGER
Credential:
Phone: 832-824-2999