Provider Demographics
NPI:1033544408
Name:SEA BREEZE PEDIATRICS, APC
Entity Type:Organization
Organization Name:SEA BREEZE PEDIATRICS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:BJORK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:858-350-4901
Mailing Address - Street 1:12395 EL CAMINO REAL
Mailing Address - Street 2:SUITE 311
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3082
Mailing Address - Country:US
Mailing Address - Phone:858-350-4901
Mailing Address - Fax:858-350-4904
Practice Address - Street 1:12395 EL CAMINO REAL
Practice Address - Street 2:SUITE 311
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3082
Practice Address - Country:US
Practice Address - Phone:858-350-4901
Practice Address - Fax:858-350-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39787261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care