Provider Demographics
NPI:1679871057
Name:PEDIATRIC WELLNESS GROUP
Entity Type:Organization
Organization Name:PEDIATRIC WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAXENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-216-7794
Mailing Address - Street 1:801 BREWSTER AVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1557
Mailing Address - Country:US
Mailing Address - Phone:650-216-7794
Mailing Address - Fax:650-216-7796
Practice Address - Street 1:801 BREWSTER AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1557
Practice Address - Country:US
Practice Address - Phone:650-216-7794
Practice Address - Fax:650-216-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty