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General NPI Number Information
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NPI Number | 1396720371
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Entity Type | Organization
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Legal Business Name | PACIFIC PEDIATRIC CARDIOLOGY MEDICAL GROUP INC
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 50 BELLEFONTAINE ST STE 405
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City | PASADENA
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State | CA
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Zip | 91105-3132
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Country | US
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Telephone | 626-796-9259
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Fax | 626-449-8560
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Provider Business Mailing Address
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Address Line | 50 BELLEFONTAINE ST STE 405
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City | PASADENA
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State | CA
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Zip | 91105-3132
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Country | US
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Telephone | 626-796-9259
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Fax | 626-449-8560
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Authorized Official
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Title or Position | PRESIDENT
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Name | LENNIS BURKE
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Credential | MD
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Telephone | 626-796-9259
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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 |
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License Number State |
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