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General NPI Number Information
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NPI Number | 1922400043
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Entity Type | Organization
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Legal Business Name | LA PROVIDENCE PEDIATRIC AND FAMILY CLINICS
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 9900 S GESSNER RD
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City | HOUSTON
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State | TX
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Zip | 77071-1008
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Country | US
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Telephone | 713-981-6002
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Fax | 713-909-6002
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Provider Business Mailing Address
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Address Line | 9900 S GESSNER RD
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City | HOUSTON
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State | TX
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Zip | 77071-1008
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Country | US
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Telephone | 713-981-6002
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Fax | 713-909-6002
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Authorized Official
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Title or Position | OWNER
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Name | DR. IFEYINWA ONWUDIWE
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Credential | MD
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Telephone | 713-981-6002
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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 | N1405
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License Number State | TX
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