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General NPI Number Information
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NPI Number | 1912247529
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Entity Type | Organization
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Legal Business Name | LIBERTY PEDIATRICS, PA
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Dates
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Enumeration Date | 02/18/2013
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 504 PECAN BLVD SUITE 100
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City | MCALLEN
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State | TX
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Zip | 78501-2345
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Country | US
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Telephone | 617-416-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 504 PECAN BLVD SUITE 100
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City | MCALLEN
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State | TX
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Zip | 78501-2345
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Country | US
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Telephone | 617-416-3900
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY MARGARET GUTIERREZ
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Credential | M.D.
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Telephone | 617-416-3900
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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 | L9720
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License Number State | TX
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