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General NPI Number Information
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NPI Number | 1982879722
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Entity Type | Organization
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Legal Business Name | HOLLISTER PEDIATRICS
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 930 SUNNYSLOPE RD SUITE E-2
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City | HOLLISTER
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State | CA
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Zip | 95023-5615
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Country | US
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Telephone | 831-630-1477
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Fax | 831-630-1531
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Provider Business Mailing Address
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Address Line | 930 SUNNYSLOPE RD SUITE E-2
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City | HOLLISTER
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State | CA
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Zip | 95023-5615
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Country | US
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Telephone | 831-630-1477
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Fax | 831-630-1531
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARIA M PEREZ
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Credential |
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Telephone | 831-630-1477
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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 | 20AX7593
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License Number State | CA
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