Organization
PEDIAQ TEXAS LLC
Active
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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