Provider Demographics
NPI:1144601857
Name:RAINBOW PEDIATRICS OF DALLAS
Entity Type:Organization
Organization Name:RAINBOW PEDIATRICS OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O. M.
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-231-3134
Mailing Address - Street 1:1701 N COLLINS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3553
Mailing Address - Country:US
Mailing Address - Phone:972-231-3134
Mailing Address - Fax:
Practice Address - Street 1:1701 N COLLINS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3553
Practice Address - Country:US
Practice Address - Phone:972-231-3134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty