Provider Demographics
NPI:1184788291
Name:CHILDREN'S PRIMARY CARE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:CHILDREN'S PRIMARY CARE MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-636-4300
Mailing Address - Street 1:3880 MURPHY CANYON ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4411
Mailing Address - Country:US
Mailing Address - Phone:858-636-4300
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:3880 MURPHY CANYON ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4411
Practice Address - Country:US
Practice Address - Phone:858-636-4300
Practice Address - Fax:858-636-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty