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HAYWARD PEDIATRIC MEDICAL CLINIC NPI 1558502625


NPI Information

NPI: 1558502625
Provider Name: HAYWARD PEDIATRIC MEDICAL CLINIC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 05D0598980

Address:
21297 FOOTHILL BLVD STE 100
HAYWARD, CA
ZIP 94541
Phone: (510) 886-8854
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HAYWARD PEDIATRIC MEDICAL CLINIC is a pediatrics in Hayward, 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. HAYWARD PEDIATRIC MEDICAL CLINIC NPI is 1558502625. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

21297 FOOTHILL BLVD STE 100
HAYWARD, CA
ZIP 94541-554
Phone: (510) 886-8854
Fax: (510) 886-6709

The provider's authorized official is Kavitha Rajaram .
The authorized official title is Physician and has the following contact phone number (510) 886-8854.

The CLIA number assigned to this NPI record is 05D0598980 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/18/2009 and was last updated on 6/25/2020.


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
1208000000XPediatricsA31628CALIFORNIAYes

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
11326055963MEDICAIDCALIFORNIA

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: 11/14/2023

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