Provider Demographics
NPI:1265183594
Name:FIRST PEDIATRICS HANFORD
Entity type:Organization
Organization Name:FIRST PEDIATRICS HANFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYDILI
Authorized Official - Middle Name:
Authorized Official - Last Name:MANIAM-MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-530-3073
Mailing Address - Street 1:450 KINGS COUNTY DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5788
Mailing Address - Country:US
Mailing Address - Phone:559-530-3073
Mailing Address - Fax:530-530-3074
Practice Address - Street 1:450 KINGS COUNTY DR STE 103
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5788
Practice Address - Country:US
Practice Address - Phone:559-530-3073
Practice Address - Fax:559-530-3074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty