Healthcare Provider Details

I. General information

NPI: 1891479812
Provider Name (Legal Business Name): PEDIATRIC GEMS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 CARRILLO DR STE 210
LOS ANGELES CA
90048-5400
US

IV. Provider business mailing address

955 CARRILLO DR STE 210
LOS ANGELES CA
90048-5400
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-7778
  • Fax: 310-888-7732
Mailing address:
  • Phone: 310-888-7778
  • Fax: 310-888-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EDMOND G SARRAF
Title or Position: MD/ CEO
Credential: MD
Phone: 310-497-2161