Provider Demographics
NPI:1619780863
Name:NORTH TEXAS RAINBOW PEDIATRICS
Entity type:Organization
Organization Name:NORTH TEXAS RAINBOW PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-441-0392
Mailing Address - Street 1:2231 PEGGY LN STE A
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5708
Mailing Address - Country:US
Mailing Address - Phone:972-272-3502
Mailing Address - Fax:
Practice Address - Street 1:2231 PEGGY LN STE A
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5708
Practice Address - Country:US
Practice Address - Phone:972-272-3502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty