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General NPI Number Information
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NPI Number | 1073793790
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Entity Type | Organization
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Legal Business Name | SAN JUAN PEDIATRICS INC
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 27372 CALLE ARROYO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2746
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Country | US
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Telephone | 949-388-9009
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Fax | 949-388-9665
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Provider Business Mailing Address
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Address Line | 27372 CALLE ARROYO
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-2746
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Country | US
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Telephone | 949-388-9009
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Fax | 949-388-9665
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Authorized Official
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Title or Position | OWNER / PHYSICIAN
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Name | DR. ASHRAF G. FAHIM
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Credential | MD
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Telephone | 949-388-9009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | GR0105670
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License Number State | CA
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