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General NPI Number Information
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NPI Number | 1396777843
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Entity Type | Organization
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Legal Business Name | CENTRAL PEDIATRICS MEDICAL GROUP
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 12598 CENTRAL AVE SUITE A
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City | CHINO
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State | CA
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Zip | 91710
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Country | US
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Telephone | 909-364-1234
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Fax | 909-364-1227
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Provider Business Mailing Address
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Address Line | 529 W LE ROY AVE
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City | ARCADIA
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State | CA
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Zip | 91007-7335
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Country | US
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Telephone | 626-446-7858
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CAROLYNE TAN LIM
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Credential | M.D.
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Telephone | 909-364-1234
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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 | A55951
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License Number State | CA
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