Provider Demographics
NPI:1275151342
Name:CALIFORNIA PEDIATRIC & ADOLESCENT CARE INC
Entity Type:Organization
Organization Name:CALIFORNIA PEDIATRIC & ADOLESCENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMEH
Authorized Official - Middle Name:MOHAMED
Authorized Official - Last Name:ELAMIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-931-4173
Mailing Address - Street 1:PO BOX 2218
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92814-0218
Mailing Address - Country:US
Mailing Address - Phone:714-931-4173
Mailing Address - Fax:
Practice Address - Street 1:3340 W BALL RD STE A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3729
Practice Address - Country:US
Practice Address - Phone:714-723-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty