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General NPI Number Information
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NPI Number | 1619424710
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Entity Type | Organization
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Legal Business Name | 123 GROW WITH US PEDIATRICS, PA
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 11836 BANDERA RD
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City | HELOTES
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State | TX
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Zip | 78023-4132
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Country | US
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Telephone | 682-551-8494
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Fax |
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Provider Business Mailing Address
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Address Line | 11836 BANDERA RD
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City | HELOTES
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State | TX
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Zip | 78023-4132
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Country | US
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Telephone | 682-551-8494
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMAD LAWENDY
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Credential | MD
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Telephone | 682-551-8494
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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 | P9390
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License Number State | TX
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