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General NPI Number Information
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NPI Number | 1881701332
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Entity Type | Organization
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Legal Business Name | CHILDRENS HEALTHCARE MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 01/31/2012
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Provider Practice Location Address
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Address Line | 550 WASHINGTON ST SUITE 300
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City | SAN DIEGO
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State | CA
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Zip | 92103-2213
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Country | US
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Telephone | 619-237-5437
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Fax | 619-243-0722
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Provider Business Mailing Address
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Address Line | 550 WASHINGTON ST SUITE 300
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City | SAN DIEGO
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State | CA
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Zip | 92103-2213
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Country | US
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Telephone | 619-237-5437
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Fax | 619-243-0722
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN H CARSON
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Credential | M.D.
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Telephone | 619-297-5437
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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 | G393080
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License Number State | CA
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