Provider Demographics
NPI:1508099409
Name:NORTHRIDGE AFTER HOURS PEDIATRIC URGENT CARE, INC
Entity Type:Organization
Organization Name:NORTHRIDGE AFTER HOURS PEDIATRIC URGENT CARE, INC
Other - Org Name:AFTER HOURS PEDIATRIC URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANESRI
Authorized Official - Middle Name:W
Authorized Official - Last Name:DE SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:747-233-3295
Mailing Address - Street 1:504 S SIERRA MADRE BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5240
Mailing Address - Country:US
Mailing Address - Phone:818-361-5437
Mailing Address - Fax:626-345-5335
Practice Address - Street 1:504 S SIERRA MADRE BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-5240
Practice Address - Country:US
Practice Address - Phone:818-361-5437
Practice Address - Fax:626-345-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88991208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty