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General NPI Number Information
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NPI Number | 1144385915
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Entity Type | Organization
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Legal Business Name | GENERAL SERVICES FOR PEDIATRICS
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 5051 JARDIN LANE
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City | CARMICHAEL
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State | CA
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Zip | 95608
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Country | US
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Telephone | 916-974-1595
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Fax | 916-965-9384
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Provider Business Mailing Address
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Address Line | 5051 JARDIN LANE
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City | CARMICHAEL
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State | CA
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Zip | 95608
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Country | US
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Telephone | 916-974-1595
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Fax | 916-965-9384
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | MR. MEHDI KHALEGHDAD ARAB
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Credential | M.D.
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Telephone | 916-974-1595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | A42130
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License Number State | CA
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