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General NPI Number Information
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NPI Number | 1659363497
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Entity Type | Organization
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Legal Business Name | THE PEDIATRIC CENTER OF SOUTH TEXAS
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5323 S MCCOLL RD SUITE 102
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City | EDINBURG
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State | TX
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Zip | 78539-9115
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Country | US
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Telephone | 956-992-9200
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Fax | 956-992-9209
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Provider Business Mailing Address
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Address Line | 5323 S MCCOLL RD SUITE 102
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City | EDINBURG
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State | TX
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Zip | 78539-9115
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Country | US
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Telephone | 956-992-9200
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Fax | 956-992-9209
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Authorized Official
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Title or Position | OFFICE ADMINISTRATOR
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Name | MRS. YVETTE MICHELLE GARZA
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Credential |
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Telephone | 956-992-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | J8999
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K3878
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H2426
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License Number State | TX
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