Provider Demographics
NPI:1215139340
Name:PEDIATRIC AND ENDOCRINOLOGY PLLC
Entity type:Organization
Organization Name:PEDIATRIC AND ENDOCRINOLOGY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NAILA
Authorized Official - Middle Name:YUNUS
Authorized Official - Last Name:SOORTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-781-8144
Mailing Address - Street 1:17115 RED OAK DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2607
Mailing Address - Country:US
Mailing Address - Phone:281-781-8144
Mailing Address - Fax:281-781-8853
Practice Address - Street 1:17115 RED OAK DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2641
Practice Address - Country:US
Practice Address - Phone:281-781-8144
Practice Address - Fax:281-781-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX290275101Medicaid
LA1550108Medicaid
LA1285638676OtherNPI-TYPE I
LAG87239Medicare UPIN
LA1285638676OtherNPI-TYPE I
TX290275101Medicaid