Provider Demographics
NPI:1821292012
Name:SAN MICHAEL PEDIATRICS INC
Entity Type:Organization
Organization Name:SAN MICHAEL PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:FARID
Authorized Official - Last Name:SHAFIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-587-6464
Mailing Address - Street 1:3612 COFFEE RD STE C
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5027
Mailing Address - Country:US
Mailing Address - Phone:661-587-6464
Mailing Address - Fax:
Practice Address - Street 1:3612 COFFEE RD STE C
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5027
Practice Address - Country:US
Practice Address - Phone:661-587-6464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84684261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care