Organization
SOUTH PADRE ISLAND PEDIATRIC CLINIC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA POWELL (PRACTICE ADMIN)
(512) 789-3844
Entity
Organization
Contact information
Practice address
110 MEDICAL DR STE 104, VICTORIA, TX 77904-3127
(361) 854-4626
(361) 572-4415
Mailing address
110 MEDICAL DR STE 104, VICTORIA, TX 77904-3127
(361) 854-4626
(361) 572-4415
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
12/08/2025
Last updated
12/08/2025
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