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General NPI Number Information
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NPI Number | 1841475738
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Entity Type | Organization
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Legal Business Name | KIDIATRICS MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 01/09/2008
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 22032 EL PASEO #160
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-3947
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Country | US
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Telephone | 949-766-5001
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Fax | 949-766-5118
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Provider Business Mailing Address
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Address Line | 22032 EL PASEO #160
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-3947
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Country | US
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Telephone | 949-766-5001
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Fax | 949-766-5118
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Authorized Official
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Title or Position | PHYSICAN/PRESIDENT
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Name | DR. NIVEDITA N MORE
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Credential | M.D.
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Telephone | 949-766-5001
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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 | A069104
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License Number State | CA
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