Provider Demographics
NPI:1932194230
Name:SALINAS PEDIATRIC MEDICAL GROUP INC
Entity type:Organization
Organization Name:SALINAS PEDIATRIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-422-9066
Mailing Address - Street 1:505 E ROMIE LN
Mailing Address - Street 2:STE K
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4031
Mailing Address - Country:US
Mailing Address - Phone:931-422-9066
Mailing Address - Fax:831-422-2580
Practice Address - Street 1:505 E ROMIE LN
Practice Address - Street 2:STE K
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4031
Practice Address - Country:US
Practice Address - Phone:931-422-9066
Practice Address - Fax:831-422-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34425208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35618Medicare UPIN