Provider Demographics
NPI:1558478313
Name:CLINICAL PEDIATRIC ASSOCIATES OF IRVING & LAS COLINAS PA
Entity type:Organization
Organization Name:CLINICAL PEDIATRIC ASSOCIATES OF IRVING & LAS COLINAS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-331-7200
Mailing Address - Street 1:2020 W STATE HIGHWAY 114 STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8648
Mailing Address - Country:US
Mailing Address - Phone:972-331-7200
Mailing Address - Fax:972-331-4858
Practice Address - Street 1:2020 W STATE HIGHWAY 114 STE 300
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8648
Practice Address - Country:US
Practice Address - Phone:972-331-7200
Practice Address - Fax:972-331-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty