Provider Demographics
NPI:1114570082
Name:PLEASANT VALLEY PEDIATRIC MEDICAL GROUP
Entity Type:Organization
Organization Name:PLEASANT VALLEY PEDIATRIC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VASKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-368-0836
Mailing Address - Street 1:2486 N PONDEROSA DR STE D211
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2470
Mailing Address - Country:US
Mailing Address - Phone:805-484-2818
Mailing Address - Fax:
Practice Address - Street 1:2486 N PONDEROSA DR STE D211
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2470
Practice Address - Country:US
Practice Address - Phone:805-484-2818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty