Provider Demographics
NPI:1497821441
Name:PEDIATRIC ACUTE CARE MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:PEDIATRIC ACUTE CARE MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:JULIA
Authorized Official - Last Name:BOTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-788-5437
Mailing Address - Street 1:PO BOX 571027
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-1027
Mailing Address - Country:US
Mailing Address - Phone:818-788-5437
Mailing Address - Fax:818-788-5436
Practice Address - Street 1:5353 BALBOA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2804
Practice Address - Country:US
Practice Address - Phone:818-788-5437
Practice Address - Fax:818-788-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47742208000000X, 2080P0202X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care MedicineGroup - Multi-Specialty