=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942356399
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALINAS VALLEY PEDIACTRIC ASSOCATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 951 BLANCO CIR STE F
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-424-7872
-----------------------------------------------------
Fax | 831-424-7877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 951 BLANCO CIR STE F
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-4451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-424-7872
-----------------------------------------------------
Fax | 831-424-7877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. MARYAM JALALI-YAZDI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 831-424-7872
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A54278
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------