Healthcare Provider Details

I. General information

NPI: 1447632401
Provider Name (Legal Business Name): PEDIATRIC PHYSICIANS GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79-180 CORPORATE CIRCLE DR. SUITE 103
LA QUINTA CA
92253-7235
US

IV. Provider business mailing address

79-180 CORPORATE CIRCLE DR. SUITE 103
LA QUINTA CA
92253-7235
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-7300
  • Fax: 760-777-7707
Mailing address:
  • Phone: 760-777-7300
  • Fax: 760-777-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A8445
License Number StateCA

VIII. Authorized Official

Name: DANIEL FRASCHETTI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 760-369-9220