Provider Demographics
NPI: | 1568816726 |
---|---|
Name: | HG PEDIATRICS, PLLC |
Entity type: | Organization |
Organization Name: | HG PEDIATRICS, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | HOMERO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GARZA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 713-208-4562 |
Mailing Address - Street 1: | 5090 RICHMOND AVE |
Mailing Address - Street 2: | SUITE 492 |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77056-7402 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1919 NORTH LOOP W STE 140 |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77008-1366 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-208-4562 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-04-14 |
Last Update Date: | 2017-05-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty | |
No | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | Group - Single Specialty |