Provider Demographics
NPI:1699239962
Name:PETITE PEDIATRICS
Entity type:Organization
Organization Name:PETITE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARISH
Authorized Official - Middle Name:LEANN
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-845-1221
Mailing Address - Street 1:510 W PUEBLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4230
Mailing Address - Country:US
Mailing Address - Phone:805-845-1221
Mailing Address - Fax:
Practice Address - Street 1:510 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4230
Practice Address - Country:US
Practice Address - Phone:805-845-1221
Practice Address - Fax:805-845-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty