Healthcare Provider Details

I. General information

NPI: 1740566694
Provider Name (Legal Business Name): MIGHTY KIDZ PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18821 PIONEER BLVD STE D
CERRITOS CA
90701-5667
US

IV. Provider business mailing address

18821 PIONEER BLVD STE D
CERRITOS CA
90701-5667
US

V. Phone/Fax

Practice location:
  • Phone: 562-403-0400
  • Fax: 562-403-0404
Mailing address:
  • Phone: 562-403-0400
  • Fax: 562-403-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA108171
License Number StateCA

VIII. Authorized Official

Name: DR. CECILIA SANTIAGO CARIGMA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 562-403-0400