Provider Demographics
NPI:1730366691
Name:LAS COLINAS PEDIATRIC ASSOCIATION
Entity type:Organization
Organization Name:LAS COLINAS PEDIATRIC ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:972-659-0404
Mailing Address - Street 1:4301 N. MAC ARTHUR
Mailing Address - Street 2:STE. 101
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038
Mailing Address - Country:US
Mailing Address - Phone:972-659-0404
Mailing Address - Fax:972-659-0184
Practice Address - Street 1:4301 N MAC ARTHUR
Practice Address - Street 2:STE. 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038
Practice Address - Country:US
Practice Address - Phone:972-659-0404
Practice Address - Fax:972-659-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8509261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care