Healthcare Provider Details

I. General information

NPI: 1457642332
Provider Name (Legal Business Name): PEDIATRIC HOSPITAL CARE ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2011
Last Update Date: 09/02/2025
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15107 VANOWEN ST
VAN NUYS CA
91405-4542
US

IV. Provider business mailing address

PO BOX 60400
PASADENA CA
91116-6400
US

V. Phone/Fax

Practice location:
  • Phone: 818-782-6800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA84467
License Number StateCA

VIII. Authorized Official

Name: DIEGO MECHOSO
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 818-902-2909