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General NPI Number Information
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NPI Number | 1528325396
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Entity Type | Organization
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Legal Business Name | TEXAS KIDZ CLINIC LLC
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 800 E DOVE AVE SUITE H1
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City | MCALLEN
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State | TX
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Zip | 78504-2262
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Country | US
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Telephone | 956-225-2401
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Fax | 888-794-8753
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Provider Business Mailing Address
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Address Line | 800 E DOVE AVE SUITE H1
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City | MCALLEN
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State | TX
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Zip | 78504-2262
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Country | US
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Telephone | 956-225-2401
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Fax | 888-794-8753
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KESTURKOPPAL MURALIDHARA
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Credential | MD
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Telephone | 956-225-2401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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