Basic Information
| Provider Information | |||||||||
| NPI: | 1932194230 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALINAS PEDIATRIC MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 E ROMIE LN | ||||||||
| Address2: | STE K | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939014031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314229066 | ||||||||
| FaxNumber: | 8314222580 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 E ROMIE LN | ||||||||
| Address2: | STE K | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939014031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314229066 | ||||||||
| FaxNumber: | 8314222580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 01/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | BRUM | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8314229066 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C34425 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.