Provider Demographics
NPI:1790535987
Name:ABC KIDS PEDIATRIC HEALTH CARE
Entity Type:Organization
Organization Name:ABC KIDS PEDIATRIC HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:GUILLEN HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-203-1081
Mailing Address - Street 1:1310 E ARLINGTON BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-9976
Mailing Address - Country:US
Mailing Address - Phone:646-203-1081
Mailing Address - Fax:
Practice Address - Street 1:1310 E ARLINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-9976
Practice Address - Country:US
Practice Address - Phone:646-203-1081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty