Healthcare Provider Details

I. General information

NPI: 1316416118
Provider Name (Legal Business Name): PEDIATRIC SPECIALTY PARTNERS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 UNIVERSITY CENTER LN STE 208
SAN DIEGO CA
92122-1054
US

IV. Provider business mailing address

8929 UNIVERSITY CENTER LN STE 208
SAN DIEGO CA
92122-1054
US

V. Phone/Fax

Practice location:
  • Phone: 858-625-0809
  • Fax: 858-625-0835
Mailing address:
  • Phone: 858-625-0809
  • Fax: 858-625-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA NAOMI CHERRY
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 858-625-0809