NPI age
18 years
Enumerated 2007-08-05
Across 729 active pediatrics providers in Texas.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (CA) | ZZZ52117Z | BLUE SHIELD # |
| 01 (CA) | W1508 | CHC-COASTAL MEDICAL CENTER -MEDICARE GROUP NUMBER |
| 05 (CA) | FHC70593F |
Solo or small practice. No other active providers share this practice address in NPPES.
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