Healthcare Provider Details

I. General information

NPI: 1053410506
Provider Name (Legal Business Name): PEDIATRIC AFFILIATES MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 MEDICAL CENTER DRIVE SUITE 400
WEST HILLS CA
91307-1963
US

IV. Provider business mailing address

7345 MEDICAL CENTER DRIVE SUITE 400
WEST HILLS CA
91307-1963
US

V. Phone/Fax

Practice location:
  • Phone: 818-883-0460
  • Fax: 818-883-2993
Mailing address:
  • Phone: 818-883-0460
  • Fax: 818-883-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA40066
License Number StateCA

VIII. Authorized Official

Name: PAMELA HANKINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-883-0460