Basic Information
| Provider Information | |||||||||
| NPI: | 1437216926 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PEDIATRIC & ADULT MEDICINE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13132 NEWPORT AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927803429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145657960 | ||||||||
| FaxNumber: | 7145657982 | ||||||||
| Practice Location | |||||||||
| Address1: | 13132 NEWPORT AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927803429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145657960 | ||||||||
| FaxNumber: | 7145657982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BRUNER | ||||||||
| AuthorizedOfficialFirstName: | DAWN | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7145657960 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.