Provider Demographics
NPI:1356632483
Name:PROVIDENCE PEDIATRICS INC
Entity Type:Organization
Organization Name:PROVIDENCE PEDIATRICS INC
Other - Org Name:VICTOR TAMASHIRO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:G
Authorized Official - Last Name:TAMASHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-365-7783
Mailing Address - Street 1:14901 RINALDI ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1204
Mailing Address - Country:US
Mailing Address - Phone:818-365-7783
Mailing Address - Fax:818-365-2193
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1204
Practice Address - Country:US
Practice Address - Phone:818-365-7783
Practice Address - Fax:818-365-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-24
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA046156261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care