| Organization Name: | PEDIATRIC PRACTICE ASSOCIATION |
| NPI Number: | 1710178181 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANA FALCON (CREDENTIALING CLERK) |
| Mailing Address: | 1408 Grant Street Roma |
| State: | TX US |
| Postal Code: | 78584 |
| Phone Number: | 9568494700 |
| Fax Number: | 9568494704 |
| NPI Enumeration Date: | 08/09/2007 |
| NPI Last Update Date: | 01/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | L4155 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |