Healthcare Provider Details

I. General information

NPI: 1255446142
Provider Name (Legal Business Name): SAN PEDRO PEDIATRICS MED GRP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1294 W 6TH ST STE #102
SAN PEDRO CA
90731-2987
US

IV. Provider business mailing address

1294 W 6TH ST STE #102
SAN PEDRO CA
90731-2987
US

V. Phone/Fax

Practice location:
  • Phone: 310-832-6487
  • Fax: 310-832-6913
Mailing address:
  • Phone: 310-832-6487
  • Fax: 310-832-6913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. FRANK BROW
Title or Position: PRESIDENT
Credential: MD
Phone: 310-832-6487