Organization
AB PEDIATRIC HEALTH CLINIC TOO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDRES D BOADELLA MD (OWNER)
(915) 577-0455
Entity
Organization
Contact information
Practice address
12001 TIERRA ESTE RD, EL PASO, TX 79938-4573
(915) 295-0455
(915) 706-4028
Mailing address
1500 FINSTERWALD PL, EL PASO, TX 79936-6011
(817) 209-4946
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P5938
TEXAS LICENSE
TX
Enumeration date
01/20/2022
Last updated
01/25/2022
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