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General NPI Number Information
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NPI Number | 1164610457
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PHYSICIANS NETWORK INC.
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 26520 CACTUS AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-3927
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Country | US
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Telephone | 888-350-2911
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Fax |
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Provider Business Mailing Address
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Address Line | 3006 S MARYLAND PKWY SUITE 505
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City | LAS VEGAS
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State | NV
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Zip | 89109-2218
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Country | US
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Telephone | 702-697-0082
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Fax | 702-369-5827
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | DONNA MESSENGER
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Credential |
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Telephone | 888-350-2911
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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 |
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License Number State |
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