=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366399685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDIATRIC UROLOGY DPC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2026
-----------------------------------------------------
Last Update Date | 03/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4220 CARTWRIGHT RD STE 502
-----------------------------------------------------
City | MISSOURI CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77459-5311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-701-9451
-----------------------------------------------------
Fax | 713-804-7975
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5318 WESLAYAN ST # 230
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77005-1048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-701-9451
-----------------------------------------------------
Fax | 713-804-7975
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANGELA MITTAL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 601-954-4989
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2088P0231X
-----------------------------------------------------
Taxonomy Name | Pediatric Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------