Provider Demographics
NPI:1295561447
Name:PEDIATRIC KIDS CLINIC PLLC
Entity type:Organization
Organization Name:PEDIATRIC KIDS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:CESAR
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-739-3256
Mailing Address - Street 1:1200 E BUS 83 STE 1200
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-4758
Mailing Address - Country:US
Mailing Address - Phone:956-739-3256
Mailing Address - Fax:
Practice Address - Street 1:1200 E BUSINESS 83 STE 1200
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-4758
Practice Address - Country:US
Practice Address - Phone:956-739-3256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care