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General NPI Number Information
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NPI Number | 1538490230
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Entity Type | Organization
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Legal Business Name | PEDIATRIC GASTROENTEROLOGY OF MONTEREY INC.
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Dates
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Enumeration Date | 01/19/2010
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 1900 GARDEN ROAD SUITE 110 PEDIATRIC GROUP OF MONTEREY
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City | MONTEREY
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State | CA
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Zip | 93940
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Country | US
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Telephone | 831-626-3259
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Fax | 888-860-1110
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Provider Business Mailing Address
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Address Line | PO BOX 204
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City | PEBBLE BEACH
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State | CA
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Zip | 93953
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Country | US
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Telephone | 831-626-3259
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Fax | 888-860-1110
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Authorized Official
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Title or Position | PRESIDENT (OF CORPORATION)/CEO
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Name | DR. ANDERS KARL DAHLSTROM
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Credential | M.D. PH.D.
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Telephone | 831-626-3259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | A52400
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License Number State | CA
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