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Organization

PEDIAQ TEXAS LLC

Active
Parent organization
PEDIAQ LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
PEDIAQ LLC
Authorized official
JON OSULLIVAN (OWNER)
21498439000
Entity
Organization

Contact information

Practice address
17101 PRESTON RD, STE 115, DALLAS, TX 75248-1331
(214) 984-3900
(972) 294-3343
Mailing address
17101 PRESTON RD, STE 115, DALLAS, TX 75248-1331
(214) 984-3900
(972) 294-3343

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
363LP0222X
Critical Care Pediatric Nurse Practitioner
226944
TX

Other

Enumeration date
09/01/2015
Last updated
09/01/2015
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