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Organization
RAINBOW CHILDREN'S CLINIC, P.A.
Active
Organization
RAINBOW CHILDREN'S CLINIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUTH BERNARDEZ TAN M.D. (PRESIDENT/OWNER)
(972) 602-1166
Entity
Organization
Contact information
Practice address
2985 S STATE HIGHWAY 360, SUITE 140, GRAND PRAIRIE, TX 75052-7615
(972) 602-1166
(972) 602-1160
Mailing address
2985 S STATE HIGHWAY 360, SUITE 140, GRAND PRAIRIE, TX 75052-7615
(972) 602-1166
(972) 602-1160
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
J8913
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
045321903
—
TX
05
—
045321904
—
TX
05
—
197309101
—
TX
05
—
197309102
—
TX
01
—
G19885
UPIN
TX
Enumeration date
04/30/2008
Last updated
09/06/2016
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