Provider Demographics
NPI:1174003743
Name:BABY PAVILION
Entity type:Organization
Organization Name:BABY PAVILION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IMTIYAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-646-1341
Mailing Address - Street 1:6070 GATEWAY BLVD E STE 105C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2027
Mailing Address - Country:US
Mailing Address - Phone:832-646-1341
Mailing Address - Fax:
Practice Address - Street 1:6070 GATEWAY BLVD E STE 105C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2027
Practice Address - Country:US
Practice Address - Phone:832-646-1341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies