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General NPI Number Information
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NPI Number | 1487077525
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Entity Type | Organization
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Legal Business Name | PEDISTAT L.P.
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 01/24/2014
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Provider Practice Location Address
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Address Line | 205 E MEDICAL CENTER BLVD STE 101
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City | WEBSTER
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State | TX
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Zip | 77598-4376
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Country | US
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Telephone | 832-215-8884
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Fax |
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Provider Business Mailing Address
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Address Line | 3017 S ISLAND DR
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City | SEABROOK
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State | TX
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Zip | 77586-1649
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Country | US
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Telephone | 832-215-8884
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAGINI PRAKASH MIRYALA
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Credential | M.D.
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Telephone | 832-215-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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