Healthcare Provider Details

I. General information

NPI: 1366652216
Provider Name (Legal Business Name): LOS ALAMITOS PEDIATRIC MEDICAL GROUP,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10861 CHERRY ST STE 305
LOS ALAMITOS CA
90720-5403
US

IV. Provider business mailing address

10861 CHERRY ST STE 305
LOS ALAMITOS CA
90720-5403
US

V. Phone/Fax

Practice location:
  • Phone: 562-598-4848
  • Fax: 562-598-2029
Mailing address:
  • Phone: 562-598-4848
  • Fax: 562-598-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDIE L MORGAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 562-598-4848