Provider Demographics
NPI:1750711511
Name:CALIFORNIA PEDIATRICS, INC.
Entity type:Organization
Organization Name:CALIFORNIA PEDIATRICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:LEONOR
Authorized Official - Last Name:NEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-295-6565
Mailing Address - Street 1:1595 GRAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2450
Mailing Address - Country:US
Mailing Address - Phone:760-295-6565
Mailing Address - Fax:760-514-4330
Practice Address - Street 1:1595 GRAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2450
Practice Address - Country:US
Practice Address - Phone:760-295-6565
Practice Address - Fax:760-514-4330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54782261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52208OtherMEDICARE
CAC54782F-1Medicaid