Provider Demographics
NPI:1861480212
Name:THE PEDIATRIC SPECIALIST
Entity Type:Organization
Organization Name:THE PEDIATRIC SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HILLEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JANAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-481-3166
Mailing Address - Street 1:145 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3307
Mailing Address - Country:US
Mailing Address - Phone:805-481-3166
Mailing Address - Fax:805-481-8237
Practice Address - Street 1:145 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3307
Practice Address - Country:US
Practice Address - Phone:805-481-3166
Practice Address - Fax:805-481-8237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48584208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR008940Medicare ID - Type UnspecifiedMEDICARE GROUP #