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General NPI Number Information
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NPI Number | 1104219781
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Entity Type | Organization
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Legal Business Name | PEDIATRIC INPATIENT CRITICAL CARE SERVICES PA
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 08/12/2015
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Provider Practice Location Address
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Address Line | 520 MADISON OAK DR
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3913
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Country | US
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Telephone | 210-297-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4346 DEPT 409
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City | HOUSTON
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State | TX
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Zip | 77210-4346
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Country | US
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Telephone | 210-558-6288
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Fax | 210-558-6289
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Authorized Official
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Title or Position | PRESIDENT
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Name | HUGO CARVAJAL
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Credential | MD
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Telephone | 210-558-6288
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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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