Provider Demographics
NPI:1396410528
Name:ICARE PEDIATRICS PLLC
Entity Type:Organization
Organization Name:ICARE PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LA TOSHA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:832-301-1856
Mailing Address - Street 1:3070 BELLFLOWER PASS LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7178
Mailing Address - Country:US
Mailing Address - Phone:832-301-1856
Mailing Address - Fax:
Practice Address - Street 1:218 W NASA PKWY STE B
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-5208
Practice Address - Country:US
Practice Address - Phone:832-301-1856
Practice Address - Fax:713-554-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty