Healthcare Provider Details

I. General information

NPI: 1861480212
Provider Name (Legal Business Name): THE PEDIATRIC SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 BRIDGE ST
ARROYO GRANDE CA
93420-3307
US

IV. Provider business mailing address

145 BRIDGE ST
ARROYO GRANDE CA
93420-3307
US

V. Phone/Fax

Practice location:
  • Phone: 805-481-3166
  • Fax: 805-481-8237
Mailing address:
  • Phone: 805-481-3166
  • Fax: 805-481-8237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA48584
License Number StateCA

VIII. Authorized Official

Name: DR. HILLEL K. JANAI
Title or Position: OWNER
Credential: M.D.
Phone: 805-481-3166