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General NPI Number Information
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NPI Number | 1508276668
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Entity Type | Organization
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Legal Business Name | MIND BODY PEDIATRIC CLINIC PLLC
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 2686 WEST ALTON GLOOR, SUITE 2.
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City | BROWNSVILLE
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State | TX
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Zip | 78520
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Country | US
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Telephone | 956-350-2844
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Fax | 956-350-2493
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Provider Business Mailing Address
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Address Line | 2686 WEST ALTON GLOOR, SUITE 2.
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City | BROWNSVILLE
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State | TX
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Zip | 78520
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Country | US
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Telephone | 956-350-2844
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Fax | 956-350-2493
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Authorized Official
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Title or Position | M.D.
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Name | MRS. NOVERA AKRAM
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Credential | M.D.
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Telephone | 956-350-5444
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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 | L9993
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License Number State | TX
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