Healthcare Provider Details

I. General information

NPI: 1417123597
Provider Name (Legal Business Name): SALIMPOUR PEDIATRIC MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15253 ROSCOE BLVD
PANORAMA CITY CA
91402-4401
US

IV. Provider business mailing address

15253 ROSCOE BLVD
PANORAMA CITY CA
91402-4401
US

V. Phone/Fax

Practice location:
  • Phone: 818-920-9947
  • Fax:
Mailing address:
  • Phone: 818-920-9947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA36971
License Number StateCA

VIII. Authorized Official

Name: RALPH SALIMPOUR
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 818-907-0322