Provider Demographics
NPI:1134651953
Name:PEDIATRIC ANGELS, INC.
Entity Type:Organization
Organization Name:PEDIATRIC ANGELS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMBIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:978-876-5343
Mailing Address - Street 1:9898 BISSONNET ST
Mailing Address - Street 2:SUITE 589
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8270
Mailing Address - Country:US
Mailing Address - Phone:978-876-5343
Mailing Address - Fax:
Practice Address - Street 1:9898 BISSONNET ST
Practice Address - Street 2:SUITE 589
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8270
Practice Address - Country:US
Practice Address - Phone:978-876-5343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251V00000XAgenciesVoluntary or Charitable