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THE PEDIATRI MEDICAL GROUP OF WATSONVILLE INC NPI 1164563862


NPI Information

NPI: 1164563862
Provider Name: THE PEDIATRI MEDICAL GROUP OF WATSONVILLE , INC
Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
222 GREEN VALLEY RD
FREEDOM, CA
ZIP 95019
Phone: (831) 728-2969
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THE PEDIATRI MEDICAL GROUP OF WATSONVILLE , INC is a pediatrics in Freedom, CA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. THE PEDIATRI MEDICAL GROUP OF WATSONVILLE , INC NPI is 1164563862. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

222 GREEN VALLEY RD
FREEDOM, CA
ZIP 95019-136
Phone: (831) 728-2969
Fax: (831) 722-9604

The provider's authorized official is Jeffrey A Roisman .
The authorized official title is President and has the following contact phone number (831) 728-2969.

The enumeration date for this NPI number is 2/8/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GROO86290MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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