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General NPI Number Information
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NPI Number | 1265989941
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Entity Type | Organization
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Legal Business Name | CENTRO DE PEDIATRIA HISPANA, PA
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 09/09/2016
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Provider Practice Location Address
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Address Line | 401 W CENTERVILLE RD SUITE 1
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City | GARLAND
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State | TX
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Zip | 75041-5458
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Country | US
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Telephone | 972-840-6500
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Fax | 972-840-6550
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Provider Business Mailing Address
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Address Line | 401 W CENTERVILLE RD SUITE 1
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City | GARLAND
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State | TX
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Zip | 75041-5458
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Country | US
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Telephone | 972-840-6500
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Fax | 972-840-6550
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Authorized Official
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Title or Position | OWNER
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Name | ROBERTO ESTRADA
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Credential | MD
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Telephone | 972-840-6500
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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 | L4927
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License Number State | TX
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