Provider Demographics
NPI:1306699814
Name:OCEAN PEDIATRICS
Entity type:Organization
Organization Name:OCEAN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-744-1177
Mailing Address - Street 1:2651 IRVINE AVE STE 152
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6649
Mailing Address - Country:US
Mailing Address - Phone:949-781-3040
Mailing Address - Fax:
Practice Address - Street 1:2651 IRVINE AVE STE 152
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-6649
Practice Address - Country:US
Practice Address - Phone:949-771-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty