Healthcare Provider Details

I. General information

NPI: 1689610123
Provider Name (Legal Business Name): CHICO PEDIATRIC MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 10/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 GOVERNORS LN
CHICO CA
95926-1991
US

IV. Provider business mailing address

10 GOVERNORS LN
CHICO CA
95926-1991
US

V. Phone/Fax

Practice location:
  • Phone: 530-343-8522
  • Fax: 530-343-3719
Mailing address:
  • Phone: 530-343-8522
  • Fax: 530-343-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG22667
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN ASARIAN
Title or Position: CEO
Credential: MD
Phone: 530-343-8522