Healthcare Provider Details

I. General information

NPI: 1629163670
Provider Name (Legal Business Name): CHILDRENS HEALTH CARE ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

100 E PENN SQ FL 9 CHILDRENS HEALTH CARE ASSOCIATES
PHILADELPHIA PA
19107-3323
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-1000
  • Fax: 267-425-9299
Mailing address:
  • Phone: 267-425-9233
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number
License Number State

VIII. Authorized Official

Name: MIXZA SANTA
Title or Position: ENROLLMENT MANAGER
Credential:
Phone: 267-425-9233