Provider Demographics
NPI:1689610123
Name:CHICO PEDIATRIC MEDICAL GROUP
Entity Type:Organization
Organization Name:CHICO PEDIATRIC MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-343-8522
Mailing Address - Street 1:10 GOVERNORS LN
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1991
Mailing Address - Country:US
Mailing Address - Phone:530-343-8522
Mailing Address - Fax:530-343-3719
Practice Address - Street 1:10 GOVERNORS LN
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1991
Practice Address - Country:US
Practice Address - Phone:530-343-8522
Practice Address - Fax:530-343-3719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G226671Medicaid
CA00G226671Medicaid