=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588038277
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHY ANGELS PEDIATRICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2015
-----------------------------------------------------
Last Update Date | 11/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1818 ROGERS RD # 1038
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-4586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-671-2806
-----------------------------------------------------
Fax | 210-526-0334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1818 ROGERS RD # 1038
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-4586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-671-2806
-----------------------------------------------------
Fax | 210-526-0334
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. PETER D PIRRAGLIA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 631-671-2806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | N4673
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------