Provider Demographics
NPI:1598952558
Name:PEDIATIC INTERVENTIONS, INC
Entity Type:Organization
Organization Name:PEDIATIC INTERVENTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:408-264-3000
Mailing Address - Street 1:PO BOX 7076
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150-7076
Mailing Address - Country:US
Mailing Address - Phone:408-246-3000
Mailing Address - Fax:408-267-4516
Practice Address - Street 1:1530 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5350
Practice Address - Country:US
Practice Address - Phone:408-264-3000
Practice Address - Fax:408-267-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 5484174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty