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General NPI Number Information
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NPI Number | 1053003368
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Entity Type | Organization
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Legal Business Name | BREAD OF LIFE PEDIATRICS PLLC
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 13111 WESTHEIMER RD STE 250
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City | HOUSTON
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State | TX
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Zip | 77077-5520
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Country | US
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Telephone | 832-866-0919
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Fax | 832-202-0808
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Provider Business Mailing Address
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Address Line | 13111 WESTHEIMER RD STE 250
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City | HOUSTON
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State | TX
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Zip | 77077-5520
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Country | US
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Telephone | 832-866-0919
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Fax | 832-202-0808
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. EVELYN OKERULU
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Credential |
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Telephone | 832-866-0919
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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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