Provider Demographics
NPI:1952845851
Name:MISSION PEDIATRICS, INC.
Entity Type:Organization
Organization Name:MISSION PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-891-1913
Mailing Address - Street 1:PO BOX 9270
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-2470
Mailing Address - Country:US
Mailing Address - Phone:951-779-1670
Mailing Address - Fax:951-779-1679
Practice Address - Street 1:114 W VINE ST
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4762
Practice Address - Country:US
Practice Address - Phone:909-891-1913
Practice Address - Fax:909-884-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty