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General NPI Number Information
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NPI Number | 1083156905
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Entity Type | Organization
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Legal Business Name | PEDIATRIC IMMEDIATE CARE OF TEXAS, PLLC
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Dates
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Enumeration Date | 11/09/2016
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 3831 E LEAGUE CITY PKWY SUITE A
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City | LEAGUE CITY
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State | TX
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Zip | 77573-7155
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Country | US
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Telephone | 281-515-2643
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Fax |
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Provider Business Mailing Address
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Address Line | 3831 E LEAGUE CITY PKWY SUITE A
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City | LEAGUE CITY
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State | TX
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Zip | 77573-7155
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAMI SUNALLAH
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Credential | MD
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Telephone | 281-515-2643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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