Provider Demographics
NPI:1760934582
Name:MISSION PEDIATRICS, INC.
Entity Type:Organization
Organization Name:MISSION PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-779-1670
Mailing Address - Street 1:PO BOX 9270
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-2470
Mailing Address - Country:US
Mailing Address - Phone:951-779-1670
Mailing Address - Fax:951-779-1679
Practice Address - Street 1:6950 BROCKTON AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3830
Practice Address - Country:US
Practice Address - Phone:951-779-1670
Practice Address - Fax:951-779-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty