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General NPI Number Information
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NPI Number | 1942897921
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Entity Type | Organization
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Legal Business Name | LA PROVIDENCE PEDIATRIC AND FAMILY CLINICS II
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Dates
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Enumeration Date | 12/24/2020
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Last Update Date | 05/15/2023
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Provider Practice Location Address
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Address Line | 2407 HIGHWAY 6 S
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City | HOUSTON
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State | TX
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Zip | 77077-5231
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Country | US
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Telephone | 713-909-3139
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Fax |
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Provider Business Mailing Address
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Address Line | 2407 HIGHWAY 6 S
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City | HOUSTON
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State | TX
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Zip | 77077-5231
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | IFEYINWA ONWUDIWE
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Credential | MD
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Telephone | 832-674-0459
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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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