Healthcare Provider Details

I. General information

NPI: 1750181236
Provider Name (Legal Business Name): SOUTH PASADENA PEDIATRICS, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 HUNTINGTON DR STE C
SOUTH PASADENA CA
91030-4994
US

IV. Provider business mailing address

1941 HUNTINGTON DR STE C
SOUTH PASADENA CA
91030-4994
US

V. Phone/Fax

Practice location:
  • Phone: 626-514-0315
  • Fax:
Mailing address:
  • Phone: 626-514-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SANDRA GILDERSLEEVE
Title or Position: FOUNDER
Credential: MD
Phone: 626-514-0315