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General NPI Number Information
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NPI Number | 1356541429
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Entity Type | Organization
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Legal Business Name | PEDIATRIC CARDIOLOGY SPECIALISTS MEDICAL GROUP INC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 350 E VANDERBILT WAY STE A
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3593
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Country | US
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Telephone | 909-886-5200
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Fax | 949-336-3827
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Provider Business Mailing Address
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Address Line | 350 E VANDERBILT WAY STE A
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3593
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Country | US
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Telephone | 909-886-5200
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Fax | 949-336-3827
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAMMAD KANAKRIYEH
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Credential | MD
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Telephone | 909-886-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 00A425260
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License Number State | CA
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