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PEDIATRIC CARDIOLOGY SPECIALISTS NPI 1356541429


NPI Information

NPI: 1356541429
Provider Name: PEDIATRIC CARDIOLOGY SPECIALISTS

Other Name: MOHAMMAD KANAKRIYEH, MD

Classification: Pediatrics - 2080P0202X
Entity Type: Organization

Specialization: Pediatric Cardiology

CLIA Number: 05D2136280

Address:
399 E. HIGHLAND AVE
STE 324
SAN BERNARDINO, CA
ZIP 92404
Phone: (909) 886-5200
Get Directions

PEDIATRIC CARDIOLOGY SPECIALISTS is a pediatric cardiology pediatrics in San Bernardino, CA. The provider is a pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. PEDIATRIC CARDIOLOGY SPECIALISTS NPI is 1356541429. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Mohammad Kanakriyeh, Md.

The provider's business location address is:

399 E. HIGHLAND AVE
STE 324
SAN BERNARDINO, CA
ZIP 92404
Phone: (909) 886-5200
Fax: (909) 382-9017

The provider's authorized official is Rebecca Lynn Stallings .
The authorized official title is Office Manager and has the following contact phone number (909) 886-5200.

The CLIA number assigned to this NPI record is 05D2136280 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/18/2007 and was last updated on 12/27/2016.


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
12080P0202XPediatricsPediatric Cardiology00A425260CALIFORNIAYes

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
11356541429MEDICAIDCALIFORNIA

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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