Provider Demographics
NPI:1417727215
Name:VINE PEDIATRICS AND LACTATION PLLC
Entity Type:Organization
Organization Name:VINE PEDIATRICS AND LACTATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARIFA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-802-4920
Mailing Address - Street 1:8990 KIRBY DR STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2853
Mailing Address - Country:US
Mailing Address - Phone:832-802-4920
Mailing Address - Fax:832-336-3947
Practice Address - Street 1:8990 KIRBY DR STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2853
Practice Address - Country:US
Practice Address - Phone:832-802-4920
Practice Address - Fax:832-336-3947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty