Provider Demographics
NPI:1871791798
Name:GENDI PEDAITRICS
Entity type:Organization
Organization Name:GENDI PEDAITRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAGIH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GENDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-477-0400
Mailing Address - Street 1:1430 PASADENA BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-3406
Mailing Address - Country:US
Mailing Address - Phone:713-477-0400
Mailing Address - Fax:713-477-2711
Practice Address - Street 1:1430 PASADENA BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-3406
Practice Address - Country:US
Practice Address - Phone:713-477-0400
Practice Address - Fax:713-477-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9680261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG18123Medicare UPIN