Provider Demographics
NPI:1427385525
Name:PALMDALE PEDIATRIC CENTER INC
Entity Type:Organization
Organization Name:PALMDALE PEDIATRIC CENTER INC
Other - Org Name:PALMDALE PEDIATRIC CENTER PPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESSAM
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:ELSHEWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-721-5211
Mailing Address - Street 1:2271 E PALMDALE BLVD
Mailing Address - Street 2:SUITE#E1
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-1340
Mailing Address - Country:US
Mailing Address - Phone:661-538-9922
Mailing Address - Fax:661-538-9199
Practice Address - Street 1:2271 E PALMDALE BLVD
Practice Address - Street 2:SUITE#E1
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-1340
Practice Address - Country:US
Practice Address - Phone:661-538-9922
Practice Address - Fax:661-538-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty