Healthcare Provider Details

I. General information

NPI: 1396410528
Provider Name (Legal Business Name): ICARE PEDIATRICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W NASA PKWY STE B
WEBSTER TX
77598-5208
US

IV. Provider business mailing address

9 PROFESSIONAL PARK DR STE 9C
WEBSTER TX
77598-4142
US

V. Phone/Fax

Practice location:
  • Phone: 832-301-1856
  • Fax: 713-554-2045
Mailing address:
  • Phone: 832-284-7083
  • Fax: 281-525-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. LA TOSHA N HOLMES
Title or Position: OWNER/PROVIDER
Credential: NURSE PRACTITIONER
Phone: 832-301-1856