Provider Demographics
NPI:1598357998
Name:PEDIATRIC CARDIOLOGY CONSULTANTS OF SOUTH TEXAS
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY CONSULTANTS OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLAWALE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLABIYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-655-4278
Mailing Address - Street 1:11485 TOEPPERWEIN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11485 TOEPPERWEIN RD STE 2
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3144
Practice Address - Country:US
Practice Address - Phone:210-372-7238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-07
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty