Provider Demographics
NPI:1659454999
Name:PEDIATRICS OF SOUTHWEST HOUSTON
Entity Type:Organization
Organization Name:PEDIATRICS OF SOUTHWEST HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOBO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-988-4334
Mailing Address - Street 1:7500 BEECHNUT ST
Mailing Address - Street 2:SUITE 352
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-4335
Mailing Address - Country:US
Mailing Address - Phone:713-988-4334
Mailing Address - Fax:713-988-6165
Practice Address - Street 1:7500 BEECHNUT ST
Practice Address - Street 2:SUITE 352
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-4335
Practice Address - Country:US
Practice Address - Phone:713-988-4334
Practice Address - Fax:713-988-6165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3367HMOtherBCBS