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General NPI Number Information
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NPI Number | 1942068077
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Entity Type | Organization
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Legal Business Name | DINO PEDIATRICS PLLC
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Dates
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Enumeration Date | 03/12/2024
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 854 SW BIG BEND TRAIL
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City | GLEN ROSE
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State | TX
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Zip | 76043-7604
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Country | US
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Telephone | 254-635-6236
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 COUNTY ROAD 2027
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City | GLEN ROSE
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State | TX
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Zip | 76043-1360
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Country | US
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Telephone | 817-675-5891
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTIE RAMIREZ
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Credential | NURSE PRACTITIONER
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Telephone | 254-635-6236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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