Healthcare Provider Details

I. General information

NPI: 1679651921
Provider Name (Legal Business Name): MISSION PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W 4TH ST
PERRIS CA
92570-2010
US

IV. Provider business mailing address

PO BOX 9270
REDLANDS CA
92375-2470
US

V. Phone/Fax

Practice location:
  • Phone: 951-943-4751
  • Fax: 951-657-3522
Mailing address:
  • Phone: 951-779-1670
  • Fax: 951-779-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY WATSON
Title or Position: CEO
Credential: MD
Phone: 951-943-4751