MEDICARE: PEDS CENTER OF ROUND ROCK PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1316413958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDS CENTER OF ROUND ROCK PA

Provider Business Mailing Address
First Line	:	1015 E 32ND ST STE 203
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2700
Country	:	US
Telephone Number	:	512-476-5437
Fax Number	:	512-476-0961

Provider Business Practice Location Address
First Line	:	1015 E 32ND ST STE 203
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2700
Country	:	US
Telephone Number	:	512-476-5437
Fax Number	:	512-476-0961

Authorized Official
Title or Position	:	OWNER
Name	:	VIVEKANAND DASARI
Credential	:	MD
Telephone Number	:	210-289-7621

Provider Enumeration Date	:	10/22/2018
Last Update Date	:	04/24/2019

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Directions to “PEDS CENTER OF ROUND ROCK PA ” Practice Location

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