Healthcare Provider Details

I. General information

NPI: 1811570211
Provider Name (Legal Business Name): MILESTONE PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 S DEMAREE ST STE A
VISALIA CA
93277-7006
US

IV. Provider business mailing address

3435 S DEMAREE ST STE A
VISALIA CA
93277-7006
US

V. Phone/Fax

Practice location:
  • Phone: 559-746-7337
  • Fax:
Mailing address:
  • Phone: 559-746-7337
  • Fax: 559-746-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. JENNIFER PACHECO
Title or Position: OWNER
Credential: FNP
Phone: 559-746-7337