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General NPI Number Information
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NPI Number | 1245309772
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Entity Type | Organization
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Legal Business Name | SANGER PEDIATRICS A MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 11/12/2010
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Provider Practice Location Address
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Address Line | 2640 JENSEN AVE
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City | SANGER
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State | CA
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Zip | 93657-9777
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Country | US
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Telephone | 559-876-1402
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Fax | 559-876-9461
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Provider Business Mailing Address
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Address Line | 2640 JENSEN AVE
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City | SANGER
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State | CA
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Zip | 93657-9777
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Country | US
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Telephone | 559-876-1402
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Fax | 559-876-9461
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EMERSON B WALLS
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Credential | D.O.
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Telephone | 559-876-1402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 20A5923
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License Number State | CA
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