Provider Demographics
NPI:1609445287
Name:SREY PEDIATRICS MEDICAL GROUP PC
Entity Type:Organization
Organization Name:SREY PEDIATRICS MEDICAL GROUP PC
Other - Org Name:HAPPY PEDIATRICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROTHTIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SREY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-528-2185
Mailing Address - Street 1:205 JASPER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1154
Mailing Address - Country:US
Mailing Address - Phone:515-707-3981
Mailing Address - Fax:
Practice Address - Street 1:31573 RANCHO PUEBLO RD STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4854
Practice Address - Country:US
Practice Address - Phone:951-528-2185
Practice Address - Fax:951-527-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-18
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty