Provider Demographics
NPI:1891332359
Name:PEDIATRIC HEALTH MEDICAL GROUP
Entity Type:Organization
Organization Name:PEDIATRIC HEALTH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:TRAGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-805-0026
Mailing Address - Street 1:14880 LOS GATOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2011
Mailing Address - Country:US
Mailing Address - Phone:408-371-7777
Mailing Address - Fax:
Practice Address - Street 1:14880 LOS GATOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2011
Practice Address - Country:US
Practice Address - Phone:408-371-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty