PEDIATRIC SUBSPECIALTY FACULTY, INC.

Provider Demographics

• NPI: 1790850279
• Name: PEDIATRIC SUBSPECIALTY FACULTY, INC.
• Entity type: Organization
• Organization Name: PEDIATRIC SUBSPECIALTY FACULTY, INC.
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: EXECUTIVE DIRECTOR
• Authorized Official - Prefix: MR
• Authorized Official - First Name: HALE
• Authorized Official - Last Name: KUHLMAN
• Authorized Official - Phone: 714-532-8649
• Mailing Address - Street 1: 455 S MAIN ST
• Mailing Address - City: ORANGE
• Mailing Address - State: CA
• Mailing Address - Zip Code: 92868-3835
• Mailing Address - Country: US
• Mailing Address - Phone: 715-094-8649
• Mailing Address - Fax: 714-509-8374
• Practice Address - Street 1: 1201 W LA VETA AVE
• Practice Address - City: ORANGE
• Practice Address - State: CA
• Practice Address - Zip Code: 92868-4203
• Practice Address - Country: US
• Practice Address - Phone: 714-509-8649
• Practice Address - Fax: 714-509-8374
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-11-21
• Last Update Date: 2022-07-21

Provider Licenses

State	License ID	Taxonomies
CA		208000000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	1265673743	Medicaid
CA	1447440417	Medicaid
CA	1902096969	Medicaid
CA	ZZZ411188Z	Other	BLUE SHIELD/455
CA	1144468620	Medicaid
CA	1356531313	Medicaid
CA	1679714844	Medicaid
CA	1801086871	Medicaid
CA	1447440409	Medicaid
CA	1194915157	Medicaid
CA	1538359591	Medicaid
CA	1740470707	Medicaid
CA	ZZZ08568Z	Other	BLUE SHIELD/1310
CA	1093905051	Medicaid
CA	1306098652	Medicaid
CA	1356531321	Medicaid
CA	1467642421	Medicaid
CA	1639310113	Medicaid
CA	1811187875	Medicaid
CA	ZZZ079907	Other	BLUE SHIELD/1201
CA	1003054420	Medicaid
CA	1386834349	Medicaid
CA	ZZZ08133Z	Other	BLUE SHIELD/1120
CA	1306098652	Medicaid