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General NPI Number Information
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NPI Number | 1972641736
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Entity Type | Organization
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Legal Business Name | EVERGREEN PEDIATRICS INC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 4205 SAN FELIPE RD #110
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City | SAN JOSE
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State | CA
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Zip | 95135-1503
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Country | US
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Telephone | 408-238-8303
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Fax | 408-238-8375
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Provider Business Mailing Address
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Address Line | 4205 SAN FELIPE RD #110
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City | SAN JOSE
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State | CA
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Zip | 95135-1503
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Country | US
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Telephone | 408-238-8303
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Fax | 408-238-8375
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PRONOTI NIGAM
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Credential | M.D.
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Telephone | 408-238-8303
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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 | A33613
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License Number State | CA
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