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General NPI Number Information
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NPI Number | 1538304134
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Entity Type | Organization
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Legal Business Name | ASPEN PEDIATRIC CLINIC,INC.
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Dates
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Enumeration Date | 12/10/2008
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 15203 11TH ST SUITE C
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City | VICTORVILLE
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State | CA
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Zip | 92395-3737
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Country | US
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Telephone | 760-951-9985
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Fax | 760-952-3387
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Provider Business Mailing Address
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Address Line | 15203 11TH ST SUITE C
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City | VICTORVILLE
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State | CA
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Zip | 92395-3737
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Country | US
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Telephone | 760-951-9985
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Fax | 760-952-3387
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARCELINO S CALIMLIM JR.
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Credential | M.D.
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Telephone | 760-951-9985
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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 | A79537
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A79537
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License Number State | CA
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