Provider Demographics
NPI:1154730729
Name:GROW PEDIATRICS AND ADOLESCENT MEDICINE PLLC
Entity type:Organization
Organization Name:GROW PEDIATRICS AND ADOLESCENT MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARREAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-467-7334
Mailing Address - Street 1:1401 PHILOMENA ST STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3574
Mailing Address - Country:US
Mailing Address - Phone:512-467-7334
Mailing Address - Fax:512-467-7335
Practice Address - Street 1:1401 PHILOMENA ST STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3574
Practice Address - Country:US
Practice Address - Phone:512-467-7334
Practice Address - Fax:512-467-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2023-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty