Provider Demographics
NPI:1710159538
Name:CLINICA PEDIATRICA HISPANA
Entity Type:Organization
Organization Name:CLINICA PEDIATRICA HISPANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-468-0222
Mailing Address - Street 1:2102 BAUER DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-5527
Mailing Address - Country:US
Mailing Address - Phone:713-468-0222
Mailing Address - Fax:713-468-0233
Practice Address - Street 1:2102 BAUER DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-5527
Practice Address - Country:US
Practice Address - Phone:713-468-0222
Practice Address - Fax:713-468-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3398208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty