Provider Demographics
NPI:1417175423
Name:PEDIATRIC SUBSPECIALTY NETWORK INC.
Entity Type:Organization
Organization Name:PEDIATRIC SUBSPECIALTY NETWORK INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-682-2775
Mailing Address - Street 1:2403 CASTILLO ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5316
Mailing Address - Country:US
Mailing Address - Phone:805-682-2775
Mailing Address - Fax:
Practice Address - Street 1:2403 CASTILLO ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5316
Practice Address - Country:US
Practice Address - Phone:805-682-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22344Medicare PIN