Provider Demographics
NPI:1528817087
Name:HENDERSON PEDIATRICS PLLC
Entity type:Organization
Organization Name:HENDERSON PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KULIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-566-0333
Mailing Address - Street 1:1490 W SUNSET RD STE 150
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6655
Mailing Address - Country:US
Mailing Address - Phone:702-566-0333
Mailing Address - Fax:702-566-0315
Practice Address - Street 1:1490 W SUNSET RD STE 150
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6655
Practice Address - Country:US
Practice Address - Phone:702-566-0333
Practice Address - Fax:702-566-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty