Provider Demographics
NPI:1770369423
Name:AURORA PEDIATRICS, LLC
Entity type:Organization
Organization Name:AURORA PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ZAUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GASANOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-250-1299
Mailing Address - Street 1:5550 GRANITE PKWY STE 265
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3726
Mailing Address - Country:US
Mailing Address - Phone:469-250-1299
Mailing Address - Fax:
Practice Address - Street 1:5550 GRANITE PKWY STE 265
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3726
Practice Address - Country:US
Practice Address - Phone:469-250-1299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation