| Organization Name: | HUTTO HEALTHY FUTURES PEDIATRIC CLINIC, LLC |
| NPI Number: | 1396018180 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IRENE GONZALEZ (CEO) |
| Mailing Address: | 210 Hwy 79 Ste. 104 Hutto |
| State: | TX US |
| Postal Code: | 786344533 |
| Phone Number: | 5123680200 |
| Fax Number: | 5126423805 |
| NPI Enumeration Date: | 02/09/2012 |
| NPI Last Update Date: | 02/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA04590 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |