Provider Demographics
NPI:1316416118
Name:PEDIATRIC SPECIALTY PARTNERS INC.
Entity Type:Organization
Organization Name:PEDIATRIC SPECIALTY PARTNERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:NAOMI
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-625-0809
Mailing Address - Street 1:8929 UNIVERSITY CENTER LN STE 208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1054
Mailing Address - Country:US
Mailing Address - Phone:858-625-0809
Mailing Address - Fax:858-625-0835
Practice Address - Street 1:8929 UNIVERSITY CENTER LN STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1054
Practice Address - Country:US
Practice Address - Phone:858-625-0809
Practice Address - Fax:858-625-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Multi-Specialty