Provider Demographics
NPI:1053042796
Name:DELAR PEDIATRICS PLLC
Entity Type:Organization
Organization Name:DELAR PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEENI
Authorized Official - Middle Name:LUZ
Authorized Official - Last Name:DE LA ROSA PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-513-5155
Mailing Address - Street 1:2 MANCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7613
Mailing Address - Country:US
Mailing Address - Phone:202-903-1319
Mailing Address - Fax:888-502-0861
Practice Address - Street 1:1430 N MACARTHUR BLVD STE 107
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4480
Practice Address - Country:US
Practice Address - Phone:817-513-5155
Practice Address - Fax:888-502-0861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3409815Medicaid