Healthcare Provider Details

I. General information

NPI: 1295912749
Provider Name (Legal Business Name): PEDIATRIC CRITICAL CARE GROUP OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE 3RD FL, PICU
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2801 ATLANTIC AVE 3RD FL, PICU
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-8743
  • Fax: 562-933-8014
Mailing address:
  • Phone: 562-933-8743
  • Fax: 562-933-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA40093
License Number StateCA

VIII. Authorized Official

Name: J CARLOS MAGGI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-933-8743