Provider Demographics
NPI:1073793790
Name:SAN JUAN PEDIATRICS INC
Entity Type:Organization
Organization Name:SAN JUAN PEDIATRICS INC
Other - Org Name:SAN JUAN PEDIATRICS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-388-9009
Mailing Address - Street 1:27372 CALLE ARROYO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2746
Mailing Address - Country:US
Mailing Address - Phone:949-388-9009
Mailing Address - Fax:949-388-9665
Practice Address - Street 1:27372 CALLE ARROYO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2746
Practice Address - Country:US
Practice Address - Phone:949-388-9009
Practice Address - Fax:949-388-9665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN JUAN PEDIATRICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-09
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGR0105670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF54806Medicare UPIN