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General NPI Number Information
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NPI Number | 1184809352
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Entity Type | Organization
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Legal Business Name | SPRING CREEK PEDIATRIC CENTER
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 110 MEDICAL DR SUITE 104
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City | VICTORIA
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State | TX
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Zip | 77904-3101
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Country | US
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Telephone | 361-572-9400
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Fax | 361-572-4415
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Provider Business Mailing Address
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Address Line | 110 MEDICAL DR SUITE 104
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City | VICTORIA
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State | TX
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Zip | 77904-3101
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Country | US
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Telephone | 361-572-9400
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Fax | 361-572-4415
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ILENE GARCIA
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Credential |
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Telephone | 361-572-9400
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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 | H1447
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License Number State | TX
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