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SOUTH COUNTIES PEDIATRIC CRITICAL CARE MEDICAL GROUP NPI 1609853688


NPI Information

NPI: 1609853688
Provider Name: SOUTH COUNTIES PEDIATRIC CRITICAL CARE MEDICAL GROUP
Classification: Pediatrics - 2080P0203X
Entity Type: Organization

Specialization: Pediatric Critical Care Medicine

Address:
17100 EUCLID ST
ATTN: PICU
FOUNTAIN VALLEY, CA
ZIP 92708
Phone: (714) 966-7253
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SOUTH COUNTIES PEDIATRIC CRITICAL CARE MEDICAL GROUP is a pediatric critical care medicine pediatrics in Fountain Valley, CA. The provider is a pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. SOUTH COUNTIES PEDIATRIC CRITICAL CARE MEDICAL GROUP NPI is 1609853688. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

17100 EUCLID ST
ATTN: PICU
FOUNTAIN VALLEY, CA
ZIP 92708-004
Phone: (714) 966-7253

The provider's authorized official is Zacharia Reda .
The authorized official title is President and has the following contact phone number (714) 966-7253.

The enumeration date for this NPI number is 12/29/2005 and was last updated on 5/28/2015.


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
12080P0214XPediatricsPediatric PulmonologyNo
22080P0204XPediatricsPediatric Emergency MedicineNo
32080P0203XPediatricsPediatric Critical Care MedicineYes

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
1ZZZ57330ZMEDICAIDCALIFORNIA

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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