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General NPI Number Information
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NPI Number | 1417727215
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Entity Type | Organization
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Legal Business Name | VINE PEDIATRICS AND LACTATION PLLC
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 8990 KIRBY DR STE 220
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City | HOUSTON
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State | TX
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Zip | 77054-2853
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Country | US
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Telephone | 832-802-4920
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Fax | 832-336-3947
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Provider Business Mailing Address
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Address Line | 8990 KIRBY DR STE 220
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City | HOUSTON
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State | TX
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Zip | 77054-2853
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Country | US
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Telephone | 832-802-4920
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Fax | 832-336-3947
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Authorized Official
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Title or Position | FOUNDER, OWNER
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Name | SHARIFA GLASS
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Credential | MD
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Telephone | 832-802-4920
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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 |
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License Number State |
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