Provider Demographics
NPI:1255604179
Name:PEDIATRIC ASSOCIATES AT RIDGE
Entity type:Organization
Organization Name:PEDIATRIC ASSOCIATES AT RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-631-5333
Mailing Address - Street 1:1200 E RIDGE RD STE 12
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1528
Mailing Address - Country:US
Mailing Address - Phone:956-631-5333
Mailing Address - Fax:956-631-5803
Practice Address - Street 1:1200 E RIDGE RD STE 12
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1528
Practice Address - Country:US
Practice Address - Phone:956-631-5333
Practice Address - Fax:877-409-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092502601Medicaid
TX192550501Medicaid