Healthcare Provider Details

I. General information

NPI: 1417967845
Provider Name (Legal Business Name): HBP PEDIATRICS MEDICAL GROUP, INC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD PEDIATRICS DEPARTMENT
PASADENA CA
91105-3010
US

IV. Provider business mailing address

223 N 1ST AVE SUITE 201
ARCADIA CA
91006-7089
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-3082
  • Fax:
Mailing address:
  • Phone: 626-821-1411
  • Fax: 626-821-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERNIE MALDONADO
Title or Position: PRESIDENT
Credential: MD
Phone: 626-397-3082