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General NPI Number Information
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NPI Number | 1780873836
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Entity Type | Organization
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Legal Business Name | MISSION PEDIATRICS
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 1005 E COURT ST STE 300
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City | SEGUIN
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State | TX
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Zip | 78155-5843
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Country | US
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Telephone | 830-303-3400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 735
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City | SEGUIN
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State | TX
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Zip | 78156-0735
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Country | US
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Telephone | 830-303-3400
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Fax |
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Authorized Official
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Title or Position | DOCTOR SHAREHOLDER
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Name | DR. MICHELE MARIE LOPEZ-GLYNN
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Credential | M.D.
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Telephone | 830-303-3400
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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 | L7015
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License Number State | TX
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