MEDICARE: CLINICA PEDIATRICA HISPANA

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	L3398	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538332911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICA PEDIATRICA HISPANA

Provider Business Mailing Address
First Line	:	9226 HAMMERLY BLVD.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-5527
Country	:	US
Telephone Number	:	713-468-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	9226 HAMMERLY BLVD.
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77080-5527
Country	:	US
Telephone Number	:	713-468-0222
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	DR. JORGE SALVADOR MENDOZA-RAMIREZ
Credential	:
Telephone Number	:	713-468-0222

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	10/14/2011

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