Provider Demographics
NPI:1780873836
Name:MISSION PEDIATRICS
Entity type:Organization
Organization Name:MISSION PEDIATRICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LOPEZ-GLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-303-3400
Mailing Address - Street 1:PO BOX 735
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78156-0735
Mailing Address - Country:US
Mailing Address - Phone:830-303-3400
Mailing Address - Fax:
Practice Address - Street 1:1005 E COURT ST
Practice Address - Street 2:STE 300
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5843
Practice Address - Country:US
Practice Address - Phone:830-303-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7015208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty