Provider Demographics
NPI:1871632141
Name:SALIMPOUR PEDIATRIC MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SALIMPOUR PEDIATRIC MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,CEO
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIMPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:818-907-0322
Mailing Address - Street 1:15477 VENTURA BLVD
Mailing Address - Street 2:300
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3006
Mailing Address - Country:US
Mailing Address - Phone:818-907-0322
Mailing Address - Fax:818-907-0360
Practice Address - Street 1:15477 VENTURA BLVD
Practice Address - Street 2:300
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3006
Practice Address - Country:US
Practice Address - Phone:818-907-0322
Practice Address - Fax:818-907-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF22777Medicare UPIN