Provider Demographics
NPI:1538304332
Name:KIDS 'N TEEN CLINICS, P.A.
Entity Type:Organization
Organization Name:KIDS 'N TEEN CLINICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ISART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-681-7334
Mailing Address - Street 1:2925 WEST T C JESTER STE 1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018
Mailing Address - Country:US
Mailing Address - Phone:713-681-7334
Mailing Address - Fax:
Practice Address - Street 1:2925 W T C JESTER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-7050
Practice Address - Country:US
Practice Address - Phone:713-681-7334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIDS 'N TEENS CLINICS, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1083175291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081128301Medicaid