Healthcare Provider Details

I. General information

NPI: 1235230624
Provider Name (Legal Business Name): MONTEREY PENINSULA PEDIATRIC MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UPPER RAGSDALE DR
MONTEREY CA
93940-5736
US

IV. Provider business mailing address

2 UPPER RAGSDALE DR
MONTEREY CA
93940-5736
US

V. Phone/Fax

Practice location:
  • Phone: 831-333-0999
  • Fax: 831-333-0909
Mailing address:
  • Phone: 831-333-0999
  • Fax: 831-333-0909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG023932
License Number StateCA

VIII. Authorized Official

Name: DR. ALAN H ROSEN
Title or Position: PARTNER
Credential: M.D.
Phone: 831-333-0999