Provider Demographics
NPI:1023015013
Name:PEDIATRIC INFECTIOUS DISEASE SPECIALISTS OF HOUSTON, P.A.
Entity Type:Organization
Organization Name:PEDIATRIC INFECTIOUS DISEASE SPECIALISTS OF HOUSTON, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:AMAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-464-9776
Mailing Address - Street 1:PO BOX 3278
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77588-3278
Mailing Address - Country:US
Mailing Address - Phone:713-464-9776
Mailing Address - Fax:713-646-9771
Practice Address - Street 1:1140 BUSINESS CENTER DR.
Practice Address - Street 2:#300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2742
Practice Address - Country:US
Practice Address - Phone:713-464-9776
Practice Address - Fax:713-464-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL32272080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151852401Medicaid
TX00117UMedicare PIN