Provider Demographics
NPI:1669645883
Name:DIAGNOSTIC PEDIATRICS ASSOCIATION
Entity Type:Organization
Organization Name:DIAGNOSTIC PEDIATRICS ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:MINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-795-0302
Mailing Address - Street 1:8111 N STADIUM DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1826
Mailing Address - Country:US
Mailing Address - Phone:713-795-0302
Mailing Address - Fax:713-795-0300
Practice Address - Street 1:8111 N STADIUM DR STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1826
Practice Address - Country:US
Practice Address - Phone:713-795-0302
Practice Address - Fax:713-795-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX360461041C0700X
TXDT80331133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty