Healthcare Provider Details

I. General information

NPI: 1225401409
Provider Name (Legal Business Name): LOUETTA PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5834 LOUETTA ROAD SUITE G
SPRING TX
77379
US

IV. Provider business mailing address

5834 LOUETTA ROAD SUITE G
SPRING TX
77379
US

V. Phone/Fax

Practice location:
  • Phone: 281-826-0016
  • Fax: 281-826-0017
Mailing address:
  • Phone: 281-826-0016
  • Fax: 281-826-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL8322
License Number StateTX

VIII. Authorized Official

Name: DR. SITTIE RAINNI DIANALAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 281-826-0016