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General NPI Number Information
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NPI Number | 1265183594
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Entity Type | Organization
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Legal Business Name | FIRST PEDIATRICS HANFORD
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 450 KINGS COUNTY DR STE 103
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City | HANFORD
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State | CA
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Zip | 93230-5788
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Country | US
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Telephone | 559-530-3073
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Fax | 559-530-3074
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Provider Business Mailing Address
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Address Line | 450 KINGS COUNTY DR STE 103
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City | HANFORD
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State | CA
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Zip | 93230-5788
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Country | US
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Telephone | 559-530-3073
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Fax | 530-530-3074
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Authorized Official
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Title or Position | PHYSICIAN / PRESIDENT
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Name | DR. MYDILI MANIAM-MOHAN
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Credential | MD
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Telephone | 559-530-3073
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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 |
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License Number State |
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