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FOOTHILL PEDIATRIC & ADOLESCENT CLINIC NPI 1952499378


NPI Information

NPI: 1952499378
Provider Name: FOOTHILL PEDIATRIC & ADOLESCENT CLINIC

Former Legal Business Name: GEORGE M MADANAT M INC

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D2198098

Address:
1330 W COVINA BLVD
SUITE 106
SAN DIMAS, CA
ZIP 91773
Phone: (909) 599-6876
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FOOTHILL PEDIATRIC & ADOLESCENT CLINIC is a pediatrics in San Dimas, 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. FOOTHILL PEDIATRIC & ADOLESCENT CLINIC NPI is 1952499378. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is George M Madanat M Inc.

The provider's business location address is:

1330 W COVINA BLVD
SUITE 106
SAN DIMAS, CA
ZIP 91773
Phone: (909) 599-6876
Fax: (909) 592-9787

The provider's authorized official is George M Madanat .
The authorized official title is President and has the following contact phone number (909) 599-6876.

The CLIA number assigned to this NPI record is 05D2198098 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/11/2006 and was last updated on 10/15/2013.


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

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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