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General NPI Number Information
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NPI Number | 1952499378
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Entity Type | Organization
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Legal Business Name | FOOTHILL PEDIATRIC & ADOLESCENT CLINIC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 10/15/2013
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Provider Practice Location Address
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Address Line | 1330 W COVINA BLVD SUITE 106
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City | SAN DIMAS
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State | CA
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Zip | 91773
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Country | US
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Telephone | 909-599-6876
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Fax | 909-592-9787
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Provider Business Mailing Address
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Address Line | 1330 W COVINA BLVD SUITE 106
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City | SAN DIMAS
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State | CA
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Zip | 91773
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Country | US
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Telephone | 909-599-6876
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Fax | 909-592-9787
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE M MADANAT
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Credential | MD
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Telephone | 909-599-6876
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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 |
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