Provider Demographics
NPI:1679343644
Name:PENINSULA PEDIATRIC THERAPY, P.C.
Entity Type:Organization
Organization Name:PENINSULA PEDIATRIC THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLARD-GENSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-601-3841
Mailing Address - Street 1:200 CAMINO AGUAJITO STE 205
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3372
Mailing Address - Country:US
Mailing Address - Phone:831-601-3841
Mailing Address - Fax:
Practice Address - Street 1:200 CAMINO AGUAJITO STE 205
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3372
Practice Address - Country:US
Practice Address - Phone:831-601-3841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty