Provider Demographics
NPI:1629376488
Name:ANTRADOS, P.A.
Entity Type:Organization
Organization Name:ANTRADOS, P.A.
Other - Org Name:CHILDREN'S CENTER OF CORPUS CHRISTI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:CHARIF
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-500-0096
Mailing Address - Street 1:2120 BALDWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-2010
Mailing Address - Country:US
Mailing Address - Phone:361-500-0096
Mailing Address - Fax:361-500-0098
Practice Address - Street 1:2120 BALDWIN BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-2010
Practice Address - Country:US
Practice Address - Phone:361-500-0096
Practice Address - Fax:361-500-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191919301Medicaid