Provider Demographics
NPI:1083627103
Name:HANISSIAN PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:HANISSIAN PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TALYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANISSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-644-1119
Mailing Address - Street 1:9809 ROWLETT RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77075-3403
Mailing Address - Country:US
Mailing Address - Phone:713-644-1119
Mailing Address - Fax:713-644-0900
Practice Address - Street 1:9809 ROWLETT RD
Practice Address - Street 2:SUITE A1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-3403
Practice Address - Country:US
Practice Address - Phone:713-644-1119
Practice Address - Fax:713-644-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8677208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179033902Medicaid