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General NPI Number Information
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NPI Number | 1205074499
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SPECIALISTS NETWORK, PA
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 12/28/2009
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Provider Practice Location Address
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Address Line | 21212 NORTHWEST FWY SUITE 235
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City | CYPRESS
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State | TX
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Zip | 77429-5884
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Country | US
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Telephone | 832-334-4004
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Fax | 832-334-4005
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Provider Business Mailing Address
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Address Line | 21212 NORTHWEST FWY SUITE 235
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City | CYPRESS
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State | TX
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Zip | 77429-5884
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Country | US
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Telephone | 832-334-4004
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Fax | 832-334-4005
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Authorized Official
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Title or Position | PRESIDENT
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Name | XAVIER VILLA
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Credential | MD
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Telephone | 832-334-4004
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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 | K8856
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | K8856
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | K8856
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License Number State | TX
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