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General NPI Number Information
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NPI Number | 1821663550
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Entity Type | Organization
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Legal Business Name | SUPERHERO PEDIATRICS, PLLC
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Dates
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Enumeration Date | 05/25/2021
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Last Update Date | 07/13/2021
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Provider Practice Location Address
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Address Line | 10925 ESTATE LN STE W-302 LYNDON PLAZA WEST
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City | DALLAS
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State | TX
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Zip | 75238-2315
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Country | US
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Telephone | 214-256-1867
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Fax | 214-617-0378
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Provider Business Mailing Address
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Address Line | 10925 ESTATE LN STE W-302 LYNDON PLAZA WEST
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City | DALLAS
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State | TX
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Zip | 75238-2315
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Country | US
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Telephone | 214-256-1867
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIO BRACERO-RODRIGUEZ
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Credential | MD
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Telephone | 214-256-1867
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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 |
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License Number State |
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