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General NPI Number Information
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NPI Number | 1578255709
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Entity Type | Organization
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Legal Business Name | JUNIPER PEDIATRICS
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 2631 GATTIS SCHOOL RD STE 160
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City | ROUND ROCK
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State | TX
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Zip | 78664-2825
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Country | US
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Telephone | 512-750-4265
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Fax |
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Provider Business Mailing Address
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Address Line | 2631 GATTIS SCHOOL RD STE 160
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City | ROUND ROCK
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State | TX
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Zip | 78664-2825
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Country | US
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Telephone | 512-750-4265
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | HANA ISAM ZIBDEH-LOUGH
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Credential | DO
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Telephone | 512-750-4265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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