Provider Demographics
NPI:1336260876
Name:CONEJO CHILDRENS MEDICAL GROUP
Entity Type:Organization
Organization Name:CONEJO CHILDRENS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PACHOREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-577-0216
Mailing Address - Street 1:558 N VENTU PARK RD STE D
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2755
Mailing Address - Country:US
Mailing Address - Phone:805-577-0216
Mailing Address - Fax:
Practice Address - Street 1:558 N VENTU PARK RD STE D
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-2755
Practice Address - Country:US
Practice Address - Phone:805-577-0216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty