Provider Demographics
NPI:1265016109
Name:SMARTSTART PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:SMARTSTART PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-503-1775
Mailing Address - Street 1:7456 CIMARRON PLAZA
Mailing Address - Street 2:SUITE 17-100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-2431
Mailing Address - Country:US
Mailing Address - Phone:915-503-1775
Mailing Address - Fax:915-207-2143
Practice Address - Street 1:7470 CIMARRON PLZ STE 17-100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-2227
Practice Address - Country:US
Practice Address - Phone:915-503-1775
Practice Address - Fax:915-207-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-06
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty