Provider Demographics
NPI:1548881063
Name:HEALTHY GUTZ PEDIATRIC CLINIC PLLC
Entity type:Organization
Organization Name:HEALTHY GUTZ PEDIATRIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-942-9500
Mailing Address - Street 1:225 E SONTERRA BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3992
Mailing Address - Country:US
Mailing Address - Phone:210-942-9500
Mailing Address - Fax:888-927-0342
Practice Address - Street 1:225 E SONTERRA BLVD STE 213
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3992
Practice Address - Country:US
Practice Address - Phone:210-924-9500
Practice Address - Fax:888-927-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty