Provider Demographics
NPI:1386755262
Name:POCKET PEDIATRICS, INC.
Entity type:Organization
Organization Name:POCKET PEDIATRICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVINDER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:KHAIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-422-7273
Mailing Address - Street 1:1355 FLORIN RD
Mailing Address - Street 2:#10
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4231
Mailing Address - Country:US
Mailing Address - Phone:916-422-7273
Mailing Address - Fax:916-422-2127
Practice Address - Street 1:1355 FLORIN RD
Practice Address - Street 2:#10
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4231
Practice Address - Country:US
Practice Address - Phone:916-422-7273
Practice Address - Fax:916-422-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0563902080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563901Medicaid
CA00A563901Medicaid