Provider Demographics
NPI:1972765634
Name:NEONATAL SPECIALISTS, PC
Entity type:Organization
Organization Name:NEONATAL SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:AURORA
Authorized Official - Last Name:CABRA
Authorized Official - Suffix:
Authorized Official - Credentials:NNP
Authorized Official - Phone:972-740-9972
Mailing Address - Street 1:6333 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 147-806
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2692
Mailing Address - Country:US
Mailing Address - Phone:972-740-9972
Mailing Address - Fax:
Practice Address - Street 1:7 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7829
Practice Address - Country:US
Practice Address - Phone:972-888-7238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544780363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0292856Medicaid