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General NPI Number Information
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NPI Number | 1578900932
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Entity Type | Organization
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Legal Business Name | PEDIATRIC CARDIAC CLINIC
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Dates
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Enumeration Date | 05/25/2013
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Last Update Date | 05/25/2013
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Provider Practice Location Address
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Address Line | 616 34TH ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-2208
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Country | US
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Telephone | 661-634-0955
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Fax | 661-634-9662
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Provider Business Mailing Address
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Address Line | 616 34TH ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-2208
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Country | US
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Telephone | 661-634-0955
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Fax | 661-634-9662
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELEFTHERIOS B SIDERIS
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Credential | MD
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Telephone | 661-634-0955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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