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Organization
PRISTINE PEDIATRICS & FAMILY MEDICINE CLINIC LLC
Active
Organization
PRISTINE PEDIATRICS & FAMILY MEDICINE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IYABODE OGUNLADE MD (OWNER)
(281) 206-4496
Entity
Organization
Contact information
Practice address
13523 HARGRAVE RD, HOUSTON, TX 77070-3829
(281) 206-4496
(281) 206-4487
Mailing address
13523 HARGRAVE RD, HOUSTON, TX 77070-3829
(281) 206-4496
(281) 206-4487
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
411162702
—
TX
Enumeration date
01/10/2019
Last updated
11/09/2020
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