Provider Demographics
NPI:1821663550
Name:SUPERHERO PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:SUPERHERO PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACERO-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-256-1867
Mailing Address - Street 1:10925 ESTATE LN STE W-302
Mailing Address - Street 2:LYNDON PLAZA WEST
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-2315
Mailing Address - Country:US
Mailing Address - Phone:214-256-1867
Mailing Address - Fax:
Practice Address - Street 1:10925 ESTATE LN STE W-302
Practice Address - Street 2:LYNDON PLAZA WEST
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-2315
Practice Address - Country:US
Practice Address - Phone:214-256-1867
Practice Address - Fax:214-617-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty