Provider Demographics
NPI:1023329117
Name:NASA CASA DE NINOS PEDIATRIC CENTER, PA
Entity type:Organization
Organization Name:NASA CASA DE NINOS PEDIATRIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIVERA-MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-323-9724
Mailing Address - Street 1:13630 BEAMER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6037
Mailing Address - Country:US
Mailing Address - Phone:281-464-3780
Mailing Address - Fax:281-464-3832
Practice Address - Street 1:13630 BEAMER RD STE 108
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089
Practice Address - Country:US
Practice Address - Phone:281-464-3780
Practice Address - Fax:281-464-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5879208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty