Healthcare Provider Details

I. General information

NPI: 1932194230
Provider Name (Legal Business Name): SALINAS PEDIATRIC MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E ROMIE LN STE K
SALINAS CA
93901-4031
US

IV. Provider business mailing address

505 E ROMIE LN STE K
SALINAS CA
93901-4031
US

V. Phone/Fax

Practice location:
  • Phone: 931-422-9066
  • Fax: 831-422-2580
Mailing address:
  • Phone: 931-422-9066
  • Fax: 831-422-2580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC34425
License Number StateCA

VIII. Authorized Official

Name: MRS. PAULA BRUM
Title or Position: PRACTICE MANAGER
Credential:
Phone: 831-422-9066