Provider Demographics
NPI:1609154038
Name:NOE VALLEY PEDIATRICS, A MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:NOE VALLEY PEDIATRICS, A MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHWANKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-641-1019
Mailing Address - Street 1:3700 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3904
Mailing Address - Country:US
Mailing Address - Phone:415-641-1019
Mailing Address - Fax:
Practice Address - Street 1:3700 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3904
Practice Address - Country:US
Practice Address - Phone:415-641-1019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG28253Medicaid