Provider Demographics
NPI:1619004157
Name:OSTEOPATHIC CENTER FOR CHILDREN
Entity Type:Organization
Organization Name:OSTEOPATHIC CENTER FOR CHILDREN
Other - Org Name:OSTEOPATHIC CENTER FOR CHILDREN AND FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OSTEOPATHIC PEDIATRICIAN/ MED. DIR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CENTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:619-583-7611
Mailing Address - Street 1:3706 RUFFIN RD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1812
Mailing Address - Country:US
Mailing Address - Phone:619-583-7611
Mailing Address - Fax:619-583-7611
Practice Address - Street 1:3706 RUFFIN ROAD
Practice Address - Street 2:SUITE 117
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:619-583-7611
Practice Address - Fax:619-583-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty