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General NPI Number Information
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NPI Number | 1932237963
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Entity Type | Organization
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Legal Business Name | COMPLETE CARE PEDIATRICS, L.L.C.
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 723 N BEERS ST STE 2E
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City | HOLMDEL
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State | NJ
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Zip | 07733-1512
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Country | US
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Telephone | 723-264-3344
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Fax | 732-264-1699
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Provider Business Mailing Address
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Address Line | 723 N BEERS ST STE 2E
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City | HOLMDEL
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State | NJ
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Zip | 07733-1512
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Country | US
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Telephone | 723-264-3344
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Fax | 732-264-1699
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Authorized Official
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Title or Position | PARTNER
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Name | DR. GRACE MERCADO YIA
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Credential | M.D.
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Telephone | 732-264-3344
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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 |
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License Number State | NJ
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