Provider Demographics
NPI:1679714844
Name:PEDIATRIC SUBSPECIALTY FACULTY,INC.
Entity Type:Organization
Organization Name:PEDIATRIC SUBSPECIALTY FACULTY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTO
Authorized Official - Prefix:
Authorized Official - First Name:HALE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-532-8649
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:PSF METABOLIC
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3835
Mailing Address - Country:US
Mailing Address - Phone:714-532-8852
Mailing Address - Fax:714-532-8362
Practice Address - Street 1:455 S MAIN ST
Practice Address - Street 2:PSF METABOLIC
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3835
Practice Address - Country:US
Practice Address - Phone:714-532-8852
Practice Address - Fax:714-532-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16177Medicare UPIN