Healthcare Provider Details

I. General information

NPI: 1114141157
Provider Name (Legal Business Name): WINDHAVEN PEDIATRICS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 W PARKER RD SUITE 324
PLANO TX
75093-8100
US

IV. Provider business mailing address

6300 W PARKER RD SUITE 324
PLANO TX
75093-8100
US

V. Phone/Fax

Practice location:
  • Phone: 972-403-5437
  • Fax: 972-403-5438
Mailing address:
  • Phone: 972-403-5437
  • Fax: 972-403-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MONICA HERRERA
Title or Position: PARTNER
Credential: M.D.
Phone: 972-403-5437