Provider Demographics
NPI:1295298578
Name:NASA PEDIATRICS TEXAS CITY PLLC
Entity type:Organization
Organization Name:NASA PEDIATRICS TEXAS CITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:IDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-MATOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-239-0980
Mailing Address - Street 1:PO BOX 890004
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-0004
Mailing Address - Country:US
Mailing Address - Phone:713-239-0980
Mailing Address - Fax:832-831-8623
Practice Address - Street 1:926 14TH ST N STE A
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77590-8902
Practice Address - Country:US
Practice Address - Phone:409-229-7487
Practice Address - Fax:831-831-8623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASA PEDIATRICS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-12
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty