ROSEVILLE PEDIATRIC MEDICAL GROUP INC NPI 1275647737

NPI Information

ROSEVILLE PEDIATRIC MEDICAL GROUP, INC is a primary care clinic center in Roseville, CA. ROSEVILLE PEDIATRIC MEDICAL GROUP, INC NPI is 1275647737. The provider is registered as an organization entity type.

The provider's business location address is:

1098 SUNRISE AVE STE 100
ROSEVILLE, CA
ZIP 95661-469
Phone: (916) 789-1798
Fax: (916) 789-0889

The provider's authorized official is Jennell Mae Serda .
The authorized official title is Manager and has the following contact phone number (916) 789-1798.

The CLIA number assigned to this NPI record is 05D0970606 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/19/2006 and was last updated on 9/17/2008.

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:

Other Identifiers

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

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.