Provider Demographics
NPI:1689846297
Name:OAK TREE PEDIATRICS AND MORE, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:OAK TREE PEDIATRICS AND MORE, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SPADARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-493-1964
Mailing Address - Street 1:430 AVENIDA DE LOS ARBOLES STE 201
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-3017
Mailing Address - Country:US
Mailing Address - Phone:805-493-1964
Mailing Address - Fax:805-241-5382
Practice Address - Street 1:430 AVENIDA DE LOS ARBOLES STE 201
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-3017
Practice Address - Country:US
Practice Address - Phone:805-493-1964
Practice Address - Fax:805-241-5382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80637207Q00000X
CAG53744208000000X
CAG57371208000000X
CAG558822080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty