Basic Information
| Provider Information | |||||||||
| NPI: | 1306098652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC SUBSPECIALTY FACULTY, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146334020 | ||||||||
| FaxNumber: | 7149535462 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146334020 | ||||||||
| FaxNumber: | 7149535462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2008 | ||||||||
| LastUpdateDate: | 05/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | KUHLMAN | ||||||||
| AuthorizedOfficialFirstName: | HALE | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7145328649 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PSF OTOLARYNGOLOGY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YP0228X | A54475 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology |
No ID Information.