Provider Demographics
NPI:1942897921
Name:LA PROVIDENCE PEDIATRIC AND FAMILY CLINICS II
Entity Type:Organization
Organization Name:LA PROVIDENCE PEDIATRIC AND FAMILY CLINICS II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IFEYINWA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONWUDIWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-674-0459
Mailing Address - Street 1:2407 HIGHWAY 6 S
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2407 HIGHWAY 6 S
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5231
Practice Address - Country:US
Practice Address - Phone:713-909-3139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-24
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty