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General NPI Number Information
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NPI Number | 1740566694
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Entity Type | Organization
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Legal Business Name | MIGHTY KIDZ PEDIATRICS
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 01/09/2013
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Provider Practice Location Address
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Address Line | 18821 PIONEER BLVD STE D
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City | CERRITOS
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State | CA
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Zip | 90701-5667
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Country | US
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Telephone | 562-403-0400
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Fax | 562-403-0404
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Provider Business Mailing Address
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Address Line | 18821 PIONEER BLVD STE D
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City | CERRITOS
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State | CA
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Zip | 90701-5667
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Country | US
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Telephone | 562-403-0400
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Fax | 562-403-0404
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CECILIA SANTIAGO CARIGMA
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Credential | M.D.
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Telephone | 562-403-0400
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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 | A108171
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License Number State | CA
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