Provider Demographics
NPI:1780231225
Name:PEARL LILLY PEDIATRICS LLC
Entity type:Organization
Organization Name:PEARL LILLY PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:OKWUCHI
Authorized Official - Last Name:EMESIH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-235-0771
Mailing Address - Street 1:23307 FIELDROSE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2879
Mailing Address - Country:US
Mailing Address - Phone:832-235-0771
Mailing Address - Fax:832-917-1975
Practice Address - Street 1:23307 FIELDROSE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2879
Practice Address - Country:US
Practice Address - Phone:832-235-0771
Practice Address - Fax:832-917-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health