Provider Demographics
NPI:1033783451
Name:IKIDS PEDIATRIC CARE PLLC
Entity type:Organization
Organization Name:IKIDS PEDIATRIC CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO (OWNER)
Authorized Official - Prefix:DR
Authorized Official - First Name:YESENIA
Authorized Official - Middle Name:FIGUEROA
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:682-703-2051
Mailing Address - Street 1:1900 W EVERMAN PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76134-4326
Mailing Address - Country:US
Mailing Address - Phone:682-703-2051
Mailing Address - Fax:682-703-2050
Practice Address - Street 1:1900 W EVERMAN PKWY STE 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76134-4326
Practice Address - Country:US
Practice Address - Phone:682-703-2051
Practice Address - Fax:682-703-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty