Healthcare Provider Details

I. General information

NPI: 1053772244
Provider Name (Legal Business Name): HILLEL K JANAI PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 SHEPARD DR 103
SANTA MARIA CA
93454-7020
US

IV. Provider business mailing address

PO BOX 3857
SAN LUIS OBISPO CA
93403-3857
US

V. Phone/Fax

Practice location:
  • Phone: 805-588-8829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA48584
License Number StateCA

VIII. Authorized Official

Name: DR. HILLEL K JANAI
Title or Position: PRESIDENT
Credential: MD
Phone: 805-588-8829