Provider Demographics
NPI:1447432026
Name:PEDIATRICS AND NEONATOLOGY, P.A.
Entity Type:Organization
Organization Name:PEDIATRICS AND NEONATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-546-1689
Mailing Address - Street 1:900 E ALTON GLOOR BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3355
Mailing Address - Country:US
Mailing Address - Phone:956-546-1689
Mailing Address - Fax:956-546-1680
Practice Address - Street 1:900 E ALTON GLOOR BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3355
Practice Address - Country:US
Practice Address - Phone:956-546-1689
Practice Address - Fax:956-546-1680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8070208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00EJ08OtherBCBS
TX112050302Medicaid
TX112050301Medicaid
TX8A6760OtherBCBS