Healthcare Provider Details

I. General information

NPI: 1932155314
Provider Name (Legal Business Name): NASSAU BAY PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E MEDICAL CENTER BLVD SUITE C
WEBSTER TX
77598-4301
US

IV. Provider business mailing address

150 E MEDICAL CENTER BLVD SUITE C
WEBSTER TX
77598-4301
US

V. Phone/Fax

Practice location:
  • Phone: 281-212-2400
  • Fax: 281-212-2499
Mailing address:
  • Phone: 281-212-2400
  • Fax: 281-212-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RAJAMMA ELIZABETH KALIA
Title or Position: PRESIDENT
Credential: MD
Phone: 281-212-2400