Provider Demographics
NPI:1952993602
Name:PEDIATRIC NURSING OF TEXAS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC NURSING OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:O
Authorized Official - Last Name:MCCANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-251-5220
Mailing Address - Street 1:839 CELESTIAL VW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-4374
Mailing Address - Country:US
Mailing Address - Phone:210-446-9526
Mailing Address - Fax:210-855-4565
Practice Address - Street 1:839 CELESTIAL VW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-4374
Practice Address - Country:US
Practice Address - Phone:210-446-9526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health