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General NPI Number Information
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NPI Number | 1033783451
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Entity Type | Organization
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Legal Business Name | IKIDS PEDIATRIC CARE PLLC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 1900 W EVERMAN PKWY STE 100
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City | FORT WORTH
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State | TX
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Zip | 76134-4326
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Country | US
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Telephone | 682-703-2051
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Fax | 682-703-2050
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Provider Business Mailing Address
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Address Line | 1900 W EVERMAN PKWY STE 100
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City | FORT WORTH
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State | TX
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Zip | 76134-4326
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Country | US
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Telephone | 682-703-2051
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Fax | 682-703-2050
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Authorized Official
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Title or Position | DO (OWNER)
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Name | DR. YESENIA FIGUEROA GUTIERREZ
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Credential | DO
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Telephone | 682-703-2051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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