Basic Information
| Provider Information | |||||||||
| NPI: | 1043549934 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | QUALITY PEDIATRICS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | QUALITY PEDIATRICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3305 N GRIMES ST | ||||||||
| Address2: | |||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882401219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753920120 | ||||||||
| FaxNumber: | 5753920122 | ||||||||
| Practice Location | |||||||||
| Address1: | 3305 N GRIMES | ||||||||
| Address2: | COMPLEX 2 SUITE 11 | ||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882409100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753920120 | ||||||||
| FaxNumber: | 5753920122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2009 | ||||||||
| LastUpdateDate: | 05/18/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5753920120 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MD2014-0535 | NM | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 261QP2300X | MD20050658 | NM | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.