Provider Demographics
NPI:1578030359
Name:PM PEDIATRICS OF CALIFORNIA
Entity Type:Organization
Organization Name:PM PEDIATRICS OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR, CRED & ENROLLMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPMSM
Authorized Official - Phone:516-207-7851
Mailing Address - Street 1:1 HOLLOW LN STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:516-869-0650
Mailing Address - Fax:516-637-9408
Practice Address - Street 1:8731 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2205
Practice Address - Country:US
Practice Address - Phone:301-312-5437
Practice Address - Fax:310-312-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-30
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty