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NPI Code Detail

MEDICARE: PEDIATRIC MEDICAL CENTER

MEDICARE: PEDIATRIC MEDICAL CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881764298
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC MEDICAL CENTER
Provider Business Mailing Address
First Line : 2921 REDONDO AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-2415
Country : US
Telephone Number : 562-426-5551
Fax Number : 562-426-9977
Provider Business Practice Location Address
First Line : 2921 REDONDO AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-2415
Country : US
Telephone Number : 562-426-5551
Fax Number : 562-426-9977
Authorized Official
Title or Position : PARTNER
Name : LOUIS P. THERIOT
Credential : M.D.
Telephone Number : 562-426-5551
Provider Enumeration Date : 11/09/2006
Last Update Date : 08/22/2020

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Directions to “PEDIATRIC MEDICAL CENTER ” Practice Location

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