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General NPI Number Information
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NPI Number | 1558502625
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Entity Type | Organization
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Legal Business Name | HAYWARD PEDIATRIC MEDICAL CLINIC
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 21297 FOOTHILL BLVD STE 100
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City | HAYWARD
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State | CA
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Zip | 94541-1554
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Country | US
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Telephone | 510-886-8854
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Fax | 510-886-6709
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Provider Business Mailing Address
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Address Line | 21297 FOOTHILL BLVD STE 100
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City | HAYWARD
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State | CA
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Zip | 94541-1554
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Country | US
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Telephone | 510-886-8854
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Fax | 510-886-6709
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KAVITHA RAJARAM
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Credential | MD
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Telephone | 510-886-8854
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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 | A31628
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License Number State | CA
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