Provider Demographics
NPI:1417125642
Name:ABC PEDIATRIC CLINIC, P.A.
Entity Type:Organization
Organization Name:ABC PEDIATRIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PARTNER/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOGOL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHLAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-746-3105
Mailing Address - Street 1:13711 WALLISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-3908
Mailing Address - Country:US
Mailing Address - Phone:713-455-7777
Mailing Address - Fax:713-453-7337
Practice Address - Street 1:13711 WALLISVILLE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-3908
Practice Address - Country:US
Practice Address - Phone:713-455-7777
Practice Address - Fax:713-453-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty