Provider Demographics
NPI:1124226402
Name:HARVEST PEDIATRICS, INC
Entity type:Organization
Organization Name:HARVEST PEDIATRICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-252-1254
Mailing Address - Street 1:1100 TRANCAS ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2908
Mailing Address - Country:US
Mailing Address - Phone:707-252-1076
Mailing Address - Fax:707-252-7923
Practice Address - Street 1:1100 TRANCAS ST
Practice Address - Street 2:SUITE 270
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2908
Practice Address - Country:US
Practice Address - Phone:707-252-1076
Practice Address - Fax:707-252-7923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39182Medicare UPIN