Provider Demographics
NPI:1144596966
Name:BENDITO PEDIATRICS INC
Entity Type:Organization
Organization Name:BENDITO PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIOMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-857-5991
Mailing Address - Street 1:22030 SHERMAN WAY
Mailing Address - Street 2:SUITE #210
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1855
Mailing Address - Country:US
Mailing Address - Phone:818-857-5991
Mailing Address - Fax:818-703-0895
Practice Address - Street 1:22030 SHERMAN WAY
Practice Address - Street 2:SUITE #210
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1855
Practice Address - Country:US
Practice Address - Phone:818-857-5991
Practice Address - Fax:818-703-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102218261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care