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General NPI Number Information
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NPI Number | 1255573465
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Entity Type | Organization
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Legal Business Name | PEDIATRIC AND ADOLESCENT CLINIC OF WEST TEXAS, P.A.
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 01/19/2010
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Provider Practice Location Address
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Address Line | 542419TH ST STE 200
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City | LUBBOCK
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State | TX
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Zip | 79407-2106
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Country | US
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Telephone | 806-722-4453
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Fax | 806-722-4461
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Provider Business Mailing Address
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Address Line | PO BOX 16367
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City | LUBBOCK
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State | TX
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Zip | 79490-6367
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Country | US
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Telephone | 806-722-4453
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Fax | 806-722-4461
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEOPOLDO A CABRERA
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Credential | M.D.
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Telephone | 806-722-4453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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